Provider Demographics
NPI:1811987480
Name:HELLER, BRANDAN (PT)
Entity type:Individual
Prefix:
First Name:BRANDAN
Middle Name:
Last Name:HELLER
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 1:8745 BLACKBIRD LN
Mailing Address - Street 2:
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-9515
Mailing Address - Country:US
Mailing Address - Phone:740-246-5483
Mailing Address - Fax:
Practice Address - Street 1:8745 BLACKBIRD LN
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-9515
Practice Address - Country:US
Practice Address - Phone:740-246-5483
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH89242251X0800X
OH10822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ16313Medicare UPIN
OHHE4132731Medicare ID - Type Unspecified