Healthcare Provider Details

I. General information

NPI: 1457283780
Provider Name (Legal Business Name): ANDREA HEITKAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 E MAIN ST
VERSAILLES OH
45380-1562
US

IV. Provider business mailing address

01473 STATE ROUTE 274
NEW BREMEN OH
45869-9769
US

V. Phone/Fax

Practice location:
  • Phone: 937-569-8726
  • Fax:
Mailing address:
  • Phone: 567-644-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT022400
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: