Provider Demographics
NPI:1033168687
Name:HEIM, BRIAN J (PT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:HEIM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 BELLE TERRE RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1935
Mailing Address - Country:US
Mailing Address - Phone:631-928-2277
Mailing Address - Fax:631-928-7572
Practice Address - Street 1:635 BELLE TERRE RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1935
Practice Address - Country:US
Practice Address - Phone:631-928-2277
Practice Address - Fax:631-928-7572
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0341350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist