Provider Demographics
NPI:1013275015
Name:HEINTZ, BETSY (CMT)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:HEINTZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:HEINTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4295 GESNER ST
Mailing Address - Street 2:STE # 2H
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4295 GESNER ST
Practice Address - Street 2:STE # 2H
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6646
Practice Address - Country:US
Practice Address - Phone:858-442-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31845225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist