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General NPI Number Information
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NPI Number | 1447915590
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Entity Type | Individual
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Provider Name | OLIVIA DIANE HEINZ PTA
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Gender | Female
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 1 W ELLIOT RD STE 109
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City | TEMPE
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State | AZ
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Zip | 85284-1310
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Country | US
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Telephone | 480-473-4341
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Fax |
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Provider Business Mailing Address
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Address Line | 451 S HAWES RD UNIT 43
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City | MESA
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State | AZ
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Zip | 85208-1544
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Country | US
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Telephone | 309-219-4536
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA-013993
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License Number State | AZ
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