Provider Demographics
NPI:1316751936
Name:HEIKKINEN, SUSAN JACKSON
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JACKSON
Last Name:HEIKKINEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5278 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-5046
Mailing Address - Country:US
Mailing Address - Phone:850-797-3824
Mailing Address - Fax:
Practice Address - Street 1:3650 BERRYHILL RD STE B5
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8321
Practice Address - Country:US
Practice Address - Phone:860-995-1364
Practice Address - Fax:850-995-4457
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist