Provider Demographics
NPI:1780962407
Name:TERESA HEITZMANN, MSPT, LLC
Entity type:Organization
Organization Name:TERESA HEITZMANN, MSPT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:HEITZMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:443-799-3174
Mailing Address - Street 1:6036 ASCENDING MOON PATH
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-2900
Mailing Address - Country:US
Mailing Address - Phone:443-799-3119
Mailing Address - Fax:443-545-7825
Practice Address - Street 1:6036 ASCENDING MOON PATH
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-2900
Practice Address - Country:US
Practice Address - Phone:443-799-3119
Practice Address - Fax:443-545-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19228261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy