Provider Demographics
NPI:1801170006
Name:MC INTYRE-HELLER, PATRICIA DALE (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DALE
Last Name:MC INTYRE-HELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W LUGONIA AVE
Mailing Address - Street 2:STE 230
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-9705
Mailing Address - Country:US
Mailing Address - Phone:909-795-2284
Mailing Address - Fax:
Practice Address - Street 1:1676 EAST 6TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223
Practice Address - Country:US
Practice Address - Phone:951-769-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADPT38188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist