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NPI Code Detail

MEDICARE: HEENAM LEEM DPT

MEDICARE: HEENAM LEEM 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
1225100000XPhysical TherapistPT309917CA

General Provider Information

NPI Number : 1649101676
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEENAM LEEM DPT
Provider Business Mailing Address
First Line : 9900 INDIANA AVE STE 1
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-5498
Country : US
Telephone Number : 951-376-1120
Fax Number : 951-376-1182
Provider Business Practice Location Address
First Line : 9900 INDIANA AVE STE 1
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-5498
Country : US
Telephone Number : 951-376-1120
Fax Number : 951-376-1182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ HEENAM LEEM DPT” Practice Location

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