Healthcare Provider Details

I. General information

NPI: 1215971726
Provider Name (Legal Business Name): JENNIFER HEILAND DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 EVELYN DR
MILLERSBURG PA
17061-1258
US

IV. Provider business mailing address

916 ROCKLEDGE DR
CARLISLE PA
17013-4280
US

V. Phone/Fax

Practice location:
  • Phone: 717-692-4708
  • Fax: 717-692-5464
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017751
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: