Healthcare Provider Details

I. General information

NPI: 1487742490
Provider Name (Legal Business Name): RICHARD JAMES HEINZ P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 CAMINO DOS RIOS STE 406
NEWBURY PARK CA
91320-1156
US

IV. Provider business mailing address

2814 CAMINO DOS RIOS STE 406
NEWBURY PARK CA
91320-1156
US

V. Phone/Fax

Practice location:
  • Phone: 805-375-1461
  • Fax: 805-498-7613
Mailing address:
  • Phone: 805-375-1461
  • Fax: 805-498-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT15158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: