Healthcare Provider Details

I. General information

NPI: 1386294403
Provider Name (Legal Business Name): JOSHUA DANIEL HEINLY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

61 SANDCASTLE
ALISO VIEJO CA
92656-3834
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-7336
  • Fax:
Mailing address:
  • Phone: 443-752-5094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number296924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: