Provider Demographics
NPI:1811248958
Name:HEERENS, HANS C (PT)
Entity type:Individual
Prefix:
First Name:HANS
Middle Name:C
Last Name:HEERENS
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:PO BOX 21604
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0162
Mailing Address - Country:US
Mailing Address - Phone:276-783-9035
Mailing Address - Fax:276-783-4878
Practice Address - Street 1:1919 ELECTRIC RD STE 1
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1641
Practice Address - Country:US
Practice Address - Phone:540-725-5300
Practice Address - Fax:540-725-5356
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist