Provider Demographics
NPI:1982948121
Name:RINKEVICH, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RINKEVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACOBUS
Mailing Address - State:PA
Mailing Address - Zip Code:17407-1258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:JACOBUS
Practice Address - State:PA
Practice Address - Zip Code:17407-1258
Practice Address - Country:US
Practice Address - Phone:304-906-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist