Healthcare Provider Details

I. General information

NPI: 1982988960
Provider Name (Legal Business Name): MEGAN KATHLEEN HEITKER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN KATHLEEN FARRELL

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 READING ROAD SUITE 105
CINCINNATI OH
45241-4816
US

IV. Provider business mailing address

10400 READING ROAD SUITE 105
CINCINNATI OH
45241-4816
US

V. Phone/Fax

Practice location:
  • Phone: 513-733-3370
  • Fax: 513-786-7893
Mailing address:
  • Phone: 513-733-3370
  • Fax: 513-786-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number013445
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: