Healthcare Provider Details

I. General information

NPI: 1114187523
Provider Name (Legal Business Name): PAUL T HEINZMANN P.T., M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 MOUNT HOPE RD SUITE A
WILLIAMSBURG MI
49690-9209
US

IV. Provider business mailing address

4480 MOUNT HOPE RD SUITE A
WILLIAMSBURG MI
49690-9209
US

V. Phone/Fax

Practice location:
  • Phone: 231-938-2425
  • Fax: 231-938-2453
Mailing address:
  • Phone: 231-938-2425
  • Fax: 231-938-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501002327
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: