Provider Demographics
NPI:1619246709
Name:BINEGAR, HEIDI JO (PTA)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JO
Last Name:BINEGAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 STEALEY AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-3471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51 SOUTHLAND DR
Practice Address - Street 2:SUITE 2300
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2244
Practice Address - Country:US
Practice Address - Phone:304-363-3167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPTA001636225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant