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General NPI Number Information
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NPI Number | 1821586652
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Entity Type | Individual
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Provider Name | KYLE HEFFNER PT
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Gender | Male
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 1435 CINCINNATI ST
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City | DAYTON
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State | OH
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Zip | 45417-4614
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Country | US
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Telephone | 937-449-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 615 MONTERAY AVE
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City | KETTERING
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State | OH
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Zip | 45419-2748
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Country | US
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Telephone | 937-260-5413
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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