Provider Demographics
NPI:1144467879
Name:HEIM, MARY EILEEN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:EILEEN
Last Name:HEIM
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 SAUNDERS SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:SANBORN
Mailing Address - State:NY
Mailing Address - Zip Code:14132-9523
Mailing Address - Country:US
Mailing Address - Phone:716-731-4176
Mailing Address - Fax:
Practice Address - Street 1:4124 SAUNDERS SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:NY
Practice Address - Zip Code:14132-9523
Practice Address - Country:US
Practice Address - Phone:716-731-4176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0044922251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics