MEDICARE: HEINEN PHYSICAL THERAPY, PC

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
1	261QP2000X	Physical Therapy Clinic/Center	4762	OK

General Provider Information

NPI Number	:	1235658261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEINEN PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	2916 CORNWALL PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-4306
Country	:	US
Telephone Number	:	405-831-7468
Fax Number	:	405-242-3057

Provider Business Practice Location Address
First Line	:	7710 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116
Country	:	US
Telephone Number	:	405-831-7468
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. BRICE HEINEN
Credential	:	PT, DPT
Telephone Number	:	405-831-7468

Provider Enumeration Date	:	09/11/2017
Last Update Date	:	06/27/2018

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