Provider Demographics
NPI:1144474024
Name:HEITZMANN, TERESA MARY (PT)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARY
Last Name:HEITZMANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6036 ASCENDING MOON PATH
Mailing Address - Street 2:W100
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-2900
Mailing Address - Country:US
Mailing Address - Phone:443-799-3119
Mailing Address - Fax:
Practice Address - Street 1:6036 ASCENDING MOON PATH
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-2900
Practice Address - Country:US
Practice Address - Phone:443-799-3119
Practice Address - Fax:443-545-7825
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist