Provider Demographics
NPI:1104509439
Name:HEINRICH, JOSHUA SAMUEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SAMUEL
Last Name:HEINRICH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 FALLEN LEAF
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3825
Mailing Address - Country:US
Mailing Address - Phone:206-422-7380
Mailing Address - Fax:
Practice Address - Street 1:905 N MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1699
Practice Address - Country:US
Practice Address - Phone:830-816-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1379358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist