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NPI Code Detail

MEDICARE: EMMETT HEINE

MEDICARE: EMMETT HEINE
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
1101YA0400XAddiction (Substance Use Disorder) CounselorMI
2225200000XPhysical Therapy Assistant5502003688MI

General Provider Information

NPI Number : 1194191296
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMETT HEINE
Provider Business Mailing Address
First Line : 3505 W CLARK RD APT C107
Second Line :
City : DEWITT
State : MI
Zip : 48820-9415
Country : US
Telephone Number : 989-501-6229
Fax Number :
Provider Business Practice Location Address
First Line : 316 MOORES RIVER DR
Second Line :
City : LANSING
State : MI
Zip : 48910-1434
Country : US
Telephone Number : 517-887-0226
Fax Number : 517-887-8121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2015
Last Update Date : 03/23/2026

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316 MOORES RIVER DR
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1639991813 — NOAH SWEET
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48910-1434
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1174345359 — JAIMIE GOODWIN
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316 MOORES RIVER DR
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48910-1434
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Directions to “ EMMETT HEINE ” Practice Location

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