Provider Demographics
NPI:1144086885
Name:HEINECKE, CHRISTINA CAROL (RCP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:CAROL
Last Name:HEINECKE
Suffix:
Gender:F
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 CASTERTON CIR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-1602
Mailing Address - Country:US
Mailing Address - Phone:410-564-8167
Mailing Address - Fax:
Practice Address - Street 1:LACONIA REHABILITATION CENTER
Practice Address - Street 2:175 BLUEBERRY LN
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246
Practice Address - Country:US
Practice Address - Phone:603-524-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Single Specialty