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NPI Code Detail

MEDICARE: JOSEPH HEIDER PTA

MEDICARE:   JOSEPH  HEIDER  PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant1533NE

General Provider Information

NPI Number : 1083183818
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH HEIDER PTA
Provider Business Mailing Address
First Line : 25117 SW PARKWAY AVE STE D
Second Line :
City : WILSONVILLE
State : OR
Zip : 97070-9697
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 610 224TH
Second Line :
City : MILFORD
State : NE
Zip : 68405-8475
Country : US
Telephone Number : 402-761-3230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2018
Last Update Date : 11/22/2018

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Directions to “ JOSEPH HEIDER PTA” Practice Location

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