Provider Demographics
NPI:1730944737
Name:HEIM, BRETT T
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:T
Last Name:HEIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8147 BUSH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-8501
Mailing Address - Country:US
Mailing Address - Phone:803-466-0374
Mailing Address - Fax:
Practice Address - Street 1:1085 SHOP RD UNIT 450
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-5418
Practice Address - Country:US
Practice Address - Phone:803-466-0374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer