Provider Demographics
NPI:1659566461
Name:LINDA P HEINZELMAN PTPC
Entity Type:Organization
Organization Name:LINDA P HEINZELMAN PTPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:HEINZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-798-1269
Mailing Address - Street 1:484 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2976
Mailing Address - Country:US
Mailing Address - Phone:518-798-1269
Mailing Address - Fax:518-792-9095
Practice Address - Street 1:484 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2976
Practice Address - Country:US
Practice Address - Phone:518-798-1269
Practice Address - Fax:518-792-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004509-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00806588Medicaid
NY00806588Medicaid