Provider Demographics
NPI:1245503309
Name:HEINTZELMAN, MATTHEW D (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:HEINTZELMAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 MIDLAND CIR
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1703
Mailing Address - Country:US
Mailing Address - Phone:610-331-5274
Mailing Address - Fax:
Practice Address - Street 1:607 MIDLAND CIR
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1703
Practice Address - Country:US
Practice Address - Phone:610-331-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007104L225100000X
PADAPT002430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist