Healthcare Provider Details

I. General information

NPI: 1487850186
Provider Name (Legal Business Name): KRISTINN IRENE HEINRICHS PHD, PT, SCS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N LITCHFIELD RD #155
GOODYEAR AZ
85338-1333
US

IV. Provider business mailing address

250 NORTH LITCHFIELD ROAD #155
GOODYEAR AZ
85338-1367
US

V. Phone/Fax

Practice location:
  • Phone: 623-882-9787
  • Fax: 623-882-9791
Mailing address:
  • Phone: 623-882-9787
  • Fax: 623-882-9791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number7254
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2251H1300X
TaxonomyHuman Factors Physical Therapist
License Number7254
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number7254
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number7254
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7254
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7254
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: