Healthcare Provider Details

I. General information

NPI: 1336168152
Provider Name (Legal Business Name): SCOTT DAVID HEISINGER D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DEYE LN
EASTSOUND WA
98245-8578
US

IV. Provider business mailing address

28 CHURCH LN
EASTSOUND WA
98245-9414
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-6604
  • Fax: 360-376-4059
Mailing address:
  • Phone: 360-376-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00007731
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: