Provider Demographics
NPI:1093557159
Name:HEITZ, PATRICIA (HEALTH & WELLNESS CO)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HEITZ
Suffix:
Gender:F
Credentials:HEALTH & WELLNESS CO
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:HEITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HEALTH & WELLNESS CO
Mailing Address - Street 1:3130 WESTNEDGE DR APT 1014
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1021
Mailing Address - Country:US
Mailing Address - Phone:518-810-2329
Mailing Address - Fax:
Practice Address - Street 1:1040 EDGEWATER CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-4514
Practice Address - Country:US
Practice Address - Phone:803-548-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach