MEDICARE: HEIKO AMPARO PINERO JR.

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	225700000X	Massage Therapist	MT014006	GA

General Provider Information

NPI Number	:	1861123986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIKO AMPARO PINERO JR.

Provider Business Mailing Address
First Line	:	810 MOUNTBURY CT
Second Line	:
City	:	CLARKSTON
State	:	GA
Zip	:	30021-2545
Country	:	US
Telephone Number	:	770-576-5906
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 MCCONNELL DR STE A
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3505
Country	:	US
Telephone Number	:	770-576-5906
Fax Number	:

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

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	06/20/2022

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Directions to “ HEIKO AMPARO PINERO JR. ” Practice Location

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