Provider Demographics
NPI:1821586652
Name:HEFFNER, KYLE (PT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:HEFFNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 MONTERAY AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2748
Mailing Address - Country:US
Mailing Address - Phone:937-260-5413
Mailing Address - Fax:
Practice Address - Street 1:1435 CINCINNATI ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-4614
Practice Address - Country:US
Practice Address - Phone:937-449-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist