Provider Demographics
NPI:1336168152
Name:HEISINGER, SCOTT DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:HEISINGER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-9414
Mailing Address - Country:US
Mailing Address - Phone:360-376-5025
Mailing Address - Fax:
Practice Address - Street 1:7 DEYE LN
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8578
Practice Address - Country:US
Practice Address - Phone:360-376-6604
Practice Address - Fax:360-376-4059
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000077312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7123748Medicaid
WA7123748Medicaid