Provider Demographics
NPI:1285716969
Name:HEIMAN, TIMOTHY NOEL (MSPT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:NOEL
Last Name:HEIMAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-0685
Mailing Address - Country:US
Mailing Address - Phone:614-257-0462
Mailing Address - Fax:614-257-0433
Practice Address - Street 1:1000 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1381
Practice Address - Country:US
Practice Address - Phone:614-257-0462
Practice Address - Fax:614-257-0433
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT007403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000479948OtherANTHEM BLUE CROSS
OH2604631Medicaid
OH510443099027OtherCARESOURCE
OH000000479948OtherANTHEM BLUE CROSS