Provider Demographics
NPI:1861600967
Name:HEATH, PAUL A (MPT, CGFI)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:HEATH
Suffix:
Gender:M
Credentials:MPT, CGFI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MERCANTILE LN
Mailing Address - Street 2:STE 107
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4302
Mailing Address - Country:US
Mailing Address - Phone:301-658-6881
Mailing Address - Fax:301-322-2563
Practice Address - Street 1:1401 MERCANTILE LN
Practice Address - Street 2:STE 107
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-4302
Practice Address - Country:US
Practice Address - Phone:301-658-6881
Practice Address - Fax:301-322-2563
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist