Provider Demographics
NPI:1700163623
Name:HEEBNER, NICHOLAS ROBERT (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ROBERT
Last Name:HEEBNER
Suffix:
Gender:M
Credentials:PHD, ATC
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Mailing Address - Street 1:720 SPORTS CENTER DRIVE
Mailing Address - Street 2:SPORTS MEDICINE RESEARCH INSTITUTE
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40506
Mailing Address - Country:US
Mailing Address - Phone:859-323-9850
Mailing Address - Fax:
Practice Address - Street 1:720 SPORTS CENTER DRIVE
Practice Address - Street 2:SPORTS MEDICINE RESEARCH INSTITUTE
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40506
Practice Address - Country:US
Practice Address - Phone:859-323-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-06
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PART0045592255A2300X
KYAT13112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer