Healthcare Provider Details

I. General information

NPI: 1639902000
Provider Name (Legal Business Name): SHANNON HEINZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 HIGGINS RD
SAN ANTONIO TX
78217-1252
US

IV. Provider business mailing address

4707 WURZBACH RD APT 10303
SAN ANTONIO TX
78238-2356
US

V. Phone/Fax

Practice location:
  • Phone: 210-826-4492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1399238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: