Provider Demographics
NPI:1942451406
Name:HEINZ, VLASTA
Entity type:Individual
Prefix:
First Name:VLASTA
Middle Name:
Last Name:HEINZ
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 1:516 HERNDON PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-6230
Mailing Address - Country:US
Mailing Address - Phone:703-478-0190
Mailing Address - Fax:703-471-0247
Practice Address - Street 1:516 HERNDON PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-6230
Practice Address - Country:US
Practice Address - Phone:703-478-0190
Practice Address - Fax:703-471-0247
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist