Healthcare Provider Details

I. General information

NPI: 1245887546
Provider Name (Legal Business Name): MICHAEL L HEINER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LIELMANIS AVE
HURLBURT FIELD FL
32544-5613
US

IV. Provider business mailing address

420 POLIFKA DR
SHAW AFB SC
29152-5100
US

V. Phone/Fax

Practice location:
  • Phone: 850-881-2337
  • Fax:
Mailing address:
  • Phone: 803-895-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1327004
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: