Healthcare Provider Details

I. General information

NPI: 1821586652
Provider Name (Legal Business Name): KYLE HEFFNER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 CINCINNATI ST
DAYTON OH
45417-4614
US

IV. Provider business mailing address

615 MONTERAY AVE
KETTERING OH
45419-2748
US

V. Phone/Fax

Practice location:
  • Phone: 937-449-0800
  • Fax:
Mailing address:
  • Phone: 937-260-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: