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Individual
BRADLEY ALLEN HEINECK
Active
Individual
BRADLEY ALLEN HEINECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6129
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7B103HE
BLUE CROSS BLUE SHIELD
MN
Enumeration date
09/16/2008
Last updated
09/16/2008
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