Ian Heinicke, PT, DPT
Individual provider Active NPI Physical Therapist · Mattawan, MI
NPI 1366923484 · NPPES record last updated Apr 16, 2023
Key facts
- NPI
- 1366923484
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5501018840 (MI)
- Practice address
- 23211 Red Arrow Hwy
Mattawan, MI 49071-9701 - Phone
- (269) 668-5930
- NPI assigned
- Aug 27, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180924000585 | MI | Practitioner - Physical Therapist in Private Practice | 5496006926 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501018840 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physiotherapy Associates Inc | Current |
Accepting new patients | |
| Physiotherapy Associates, Inc. | Physical Therapist | Current | Accepting new patients |
| Physiotherapy Associates Inc | Current |
Accepting new patients |
Locations
23211 Red Arrow Hwy
Mattawan, MI 49071
Phone (269) 668-5930
11561 Edgerton Ave NE
Rockford, MI 49341
Phone (616) 866-2727
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501018840 | MI | Yes |
Addresses
Primary practice location
23211 Red Arrow Hwy
Mattawan, MI 49071-9701
Mailing address
980 Niagara Dr
Lawton, MI 49065-9532
Other providers in Mattawan, MI
- Great Lakes Family Chiropractic PLC
- Mikayla Grieser
- Kirsten Haroldson
- Healing House Therapy LLC
- Morgan Heckaman
- Elizabeth Marie Henk
- Aracely Hernandez
- Allison Lee Hibma
- Martin Friedrich Hoffmann
- Jay Phillip Horwich
All providers in Mattawan, MI · Physical Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.