Healthcare Provider Details

I. General information

NPI: 1477852416
Provider Name (Legal Business Name): ANGELA HEINTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 S MARIGOLD LN
KENT OH
44240-5308
US

IV. Provider business mailing address

329 PRINCETON AVE
PITTSBURGH PA
15229-1408
US

V. Phone/Fax

Practice location:
  • Phone: 412-443-9364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003481
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: