Provider Demographics
NPI:1760299721
Name:HEINIGER, JORDAN (PT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HEINIGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 S EMERSON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1949
Mailing Address - Country:US
Mailing Address - Phone:317-559-2673
Mailing Address - Fax:317-559-6117
Practice Address - Street 1:432 S EMERSON AVE STE 110
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1949
Practice Address - Country:US
Practice Address - Phone:317-559-2673
Practice Address - Fax:317-559-6117
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014659A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist