MEDICARE: RENEE JEFFREYS HEIL PHD

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	224Y00000X	Clinical Exercise Physiologist	788281	IN

General Provider Information

NPI Number	:	1679174775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE JEFFREYS HEIL PHD

Provider Business Mailing Address
First Line	:	161 HIBISCUS DR
Second Line	:
City	:	FORT MYERS BEACH
State	:	FL
Zip	:	33931-3831
Country	:	US
Telephone Number	:	859-816-1124
Fax Number	:

Provider Business Practice Location Address
First Line	:	15971 MCGREGOR BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-2552
Country	:	US
Telephone Number	:	801-896-7272
Fax Number	:

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

Provider Enumeration Date	:	11/04/2020
Last Update Date	:	11/04/2020

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