Individual
MR. DONALD GARY HEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
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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