MEDICARE: MICHAEL HEIDINGER

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	15201	NC

General Provider Information

NPI Number	:	1538569728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HEIDINGER

Provider Business Mailing Address
First Line	:	1516 E FRANKLIN ST STE 104
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-2812
Country	:	US
Telephone Number	:	919-968-4777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 E FRANKLIN ST STE 104
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-2812
Country	:	US
Telephone Number	:	919-968-4777
Fax Number	:

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

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	08/26/2014

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