Healthcare Provider Details

I. General information

NPI: 1194191296
Provider Name (Legal Business Name): EMMETT HEINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 S PISTOL HILL RD
VAIL AZ
85641-6144
US

IV. Provider business mailing address

8215 S PISTOL HILL RD
VAIL AZ
85641-6144
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-7711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502003688
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: