MEDICARE: KOURTNEY HEITZ PT

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	225100000X	Physical Therapist	2009034737	MO

General Provider Information

NPI Number	:	1710210604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOURTNEY HEITZ PT

Provider Business Mailing Address
First Line	:	4273 KEATON CROSSING BLVD
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63368-8220
Country	:	US
Telephone Number	:	636-206-4225
Fax Number	:	636-422-1051

Provider Business Practice Location Address
First Line	:	118 RICHARDSON XING
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-6023
Country	:	US
Telephone Number	:	636-206-4146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	03/29/2022

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