MEDICARE: HEIDI R IRWIN 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	5501012774	MI

General Provider Information

NPI Number	:	1497798326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI R IRWIN DPT

Provider Business Mailing Address
First Line	:	4053 S LAPEER RD
Second Line	:	STE C
City	:	METAMORA
State	:	MI
Zip	:	48455-8721
Country	:	US
Telephone Number	:	810-678-3202
Fax Number	:

Provider Business Practice Location Address
First Line	:	4053 S LAPEER RD
Second Line	:	STE C
City	:	METAMORA
State	:	MI
Zip	:	48455-8721
Country	:	US
Telephone Number	:	810-678-3202
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/17/2016

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Directions to “ HEIDI R IRWIN DPT” Practice Location

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