Provider Demographics
NPI:1437794278
Name:HEIDT, DANIELLE REBECCA (MS, ATC, SCAT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:REBECCA
Last Name:HEIDT
Suffix:
Gender:F
Credentials:MS, ATC, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-1917
Mailing Address - Country:US
Mailing Address - Phone:404-664-6590
Mailing Address - Fax:
Practice Address - Street 1:105 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2960
Practice Address - Country:US
Practice Address - Phone:864-541-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer