Provider Demographics
NPI:1851551170
Name:HEINE, ELINA R (PT)
Entity Type:Individual
Prefix:MS
First Name:ELINA
Middle Name:R
Last Name:HEINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1621 EDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3132
Mailing Address - Country:US
Mailing Address - Phone:805-987-2715
Mailing Address - Fax:805-987-2715
Practice Address - Street 1:1115 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2801
Practice Address - Country:US
Practice Address - Phone:805-306-1840
Practice Address - Fax:805-306-1839
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist