Healthcare Provider Details

I. General information

NPI: 1396781472
Provider Name (Legal Business Name): RICHARD HEYTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 E CANAL DR STE 3
TURLOCK CA
95380-4550
US

IV. Provider business mailing address

PO BOX 4978
MODESTO CA
95352-4978
US

V. Phone/Fax

Practice location:
  • Phone: 209-669-3290
  • Fax:
Mailing address:
  • Phone: 209-575-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: