Individual
MR. DONALD GARY HEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
7310 RITCHIE HWY, SUITE 500, GLEN BURNIE, MD 21061-3065
(410) 766-4435
(410) 766-4437
Mailing address
350 NEW FIDELITY CT, GARNER, NC 27529-2665
(919) 258-2714
(410) 648-4878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15332
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1359660
AETNA USHEALTHCARE
MD
01
—
145799600
OWCP/DEPARTMENT OF LABOR
MD
01
—
147433401
ACS / US DEPT OF LABOR
MD
01
—
1784629
UNITED HEALTHCARE
MD
01
—
521200786
UNITED HEALTH CARE
MD
01
—
756LN288
RAILROAD MEDICARE
MD
Enumeration date
07/29/2006
Last updated
05/07/2020
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