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General NPI Number Information
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NPI Number | 1043895600
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Entity Type | Individual
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Provider Name | RYAN HEILMAN DPT
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Gender | Male
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 457 S FITNESS PL STE 100
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City | EAGLE
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State | ID
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Zip | 83616-6568
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Country | US
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Telephone | 208-939-3332
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Fax | 208-939-3338
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Provider Business Mailing Address
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Address Line | 457 S FITNESS PL STE 100
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City | EAGLE
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State | ID
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Zip | 83616-6568
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Country | US
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Telephone | 208-939-3332
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Fax | 208-939-3338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT61138871
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4571562
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License Number State | ID
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