Provider Demographics
NPI:1255788964
Name:HEITMANN, HOLLY (DPT)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:HEITMANN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:BAKKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MST, BS
Mailing Address - Street 1:4362 NUMBER 9 RD
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14561-9559
Mailing Address - Country:US
Mailing Address - Phone:585-794-3464
Mailing Address - Fax:
Practice Address - Street 1:4362 NUMBER 9 RD
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NY
Practice Address - Zip Code:14561-9559
Practice Address - Country:US
Practice Address - Phone:585-794-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist