Provider Demographics
NPI:1356357453
Name:HEINZER, NICHOLAS J (PT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:HEINZER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2316
Mailing Address - Country:US
Mailing Address - Phone:330-702-0110
Mailing Address - Fax:330-702-0510
Practice Address - Street 1:4329 MAHONING AVE NW STE B
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1974
Practice Address - Country:US
Practice Address - Phone:330-847-7819
Practice Address - Fax:330-847-8192
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2660259Medicaid
OH2660259Medicaid