NPIMap

Individual provider Active NPI

Tina Louise Heydenburg, PT

  • Physical Therapist
  • Fernandina Beach, FL
National Provider Identifier
1952414906
Registry record updated Mar 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 16749 Issued in FL
Practice address
1897 Island Walk Way
Unit 5
Fernandina Beach, FL 32034-1948
Phone
(904) 261-4664
Fax
(904) 261-5852
NPI assigned
Aug 16, 2006
Last updated
Mar 5, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT 16749 FL Primary
Physical Therapist 225100000X 9844 CO

Addresses

Primary practice location

1897 Island Walk Way
Unit 5
Fernandina Beach, FL 32034-1948

Mailing address

PO Box 949
Rome, GA 30162-0949
Phone (706) 236-2774

Other names 1

  • Ms. Tina Louise Heydenburg Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
9844COMDDentist
PT 16749FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advance Rehabilitation & Consulting Limited Partnership Physical Therapist Past Accepting new patients
Advance Rehabilitation & Consulting Limited Partnership Physical Therapist PastSince Mar 9, 2015 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362441600000",
    "number": "1952414906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 949",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301620949",
            "telephone_number": "706-236-2774",
            "fax_number": "706-236-2783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1897 ISLAND WALK WAY",
            "address_2": "UNIT 5",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320341948",
            "telephone_number": "904-261-4664",
            "fax_number": "904-261-5852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEYDENBURG",
        "first_name": "TINA",
        "middle_name": "LOUISE",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2013-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 16749",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "9844",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "HEYDENBURG",
            "middle_name": "LOUISE",
            "prefix": "MS.",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fernandina Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.