MEDICARE: JORDAN A HEINOLD DPT

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
1	225100000X	Physical Therapist	PT020382	OH

General Provider Information

NPI Number	:	1417648171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN A HEINOLD DPT

Provider Business Mailing Address
First Line	:	6480 HARRISON AVE STE 201
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7961
Country	:	US
Telephone Number	:	513-354-7662
Fax Number	:	513-354-7651

Provider Business Practice Location Address
First Line	:	500 E BUSINESS WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-2374
Country	:	US
Telephone Number	:	513-389-3666
Fax Number	:	513-389-3665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	01/28/2026

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