Ian Heinicke, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501018840 Issued in MI

Practice address

23211 Red Arrow Hwy
Mattawan, MI 49071-9701

Phone

(269) 668-5930

NPI assigned

Aug 27, 2018

Last updated

Apr 16, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Physiotherapy Associates, Inc.

  dba NovaCare Rehabilitation

  • Rehabilitation Clinic/Center
  • Waterford, MI
  • NPI 1679645295

  Physical Therapist

  Medicare reassignment NPD
• Physiotherapy Associates Inc

  dba NovaCare Rehabilitation

  • Physical Therapy Clinic/Center
  • Mattawan, MI
  • NPI 1225761034
  NPD
• Physiotherapy Associates Inc

  dba Select Physical Therapy

  • Physical Therapy Clinic/Center
  • Estero, FL
  • NPI 1720039902
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681603200000",
    "number": "1366923484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 NIAGARA DR",
            "city": "LAWTON",
            "state": "MI",
            "postal_code": "490659532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23211 RED ARROW HWY",
            "city": "MATTAWAN",
            "state": "MI",
            "postal_code": "490719701",
            "telephone_number": "269-668-5930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINICKE",
        "first_name": "IAN",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-27",
        "last_updated": "2023-04-16",
        "certification_date": "2023-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501018840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Great Lakes Family Chiropractic PLC
• Kirsten Haroldson
• Healing House Therapy LLC
• Morgan Heckaman
• Nikola David Hedin
• Elizabeth Marie Henk, MS, AT, ATC
• Aracely Hernandez
• Allison Lee Hibma
• Martin Friedrich Hoffmann, MD
• Jay Phillip Horwich, M.D.

• Physical Therapist in Mattawan, MI
• Providers in Mattawan, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.