Provider Demographics
NPI:1295329407
Name:HEANEY, HUGH JOSEPH
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:JOSEPH
Last Name:HEANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 SHADY OAK ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5203
Mailing Address - Country:US
Mailing Address - Phone:510-333-8009
Mailing Address - Fax:
Practice Address - Street 1:2037 SHADY OAK ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5203
Practice Address - Country:US
Practice Address - Phone:510-333-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer