=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790429546
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY HEITSCHMIDT PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2022
-----------------------------------------------------
Last Update Date | 04/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 RIVERHILL DR
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30606-4067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-521-8086
-----------------------------------------------------
Fax | 855-232-8604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 RIVERHILL DR
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30606-4067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-521-8086
-----------------------------------------------------
Fax | 855-232-8604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT007927
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------