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NPI Code Detail

MEDICARE: MICHELLE L HEEBNER LPT

MEDICARE:   MICHELLE L HEEBNER  LPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1114346TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18T4790OTHERTXBCBS

General Provider Information

NPI Number : 1053421396
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE L HEEBNER LPT
Provider Business Mailing Address
First Line : 2225 WILLIAMS TRACE BLVD
Second Line : SUITE 104
City : SUGAR LAND
State : TX
Zip : 77478-4513
Country : US
Telephone Number : 281-980-2997
Fax Number : 281-980-0142
Provider Business Practice Location Address
First Line : 2225 WILLIAMS TRACE BLVD
Second Line : SUITE 104
City : SUGAR LAND
State : TX
Zip : 77478-4513
Country : US
Telephone Number : 281-980-2997
Fax Number : 281-980-0142
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/08/2007

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Practice Fax:
1669482550 — CUSTOMIZED HEALTH CARE SERVICES,INC.
Practice Location Address:
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1659481919 — PAULA M. BROMAN MSPT
Practice Location Address:
2225 WILLIAMS TRACE BLVD , SUITE 104
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1205946464 — BARRY A BROMAN MSPT
Practice Location Address:
2225 WILLIAMS TRACE BLVD , SUITE 104
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77478-4513
Practice Phone: 281-980-2997
Practice Fax: 281-980-0142

Directions to “ MICHELLE L HEEBNER LPT” Practice Location

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