Individual
BRADLEY ALLEN HEINECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
66 SHADY OAK CT, WINONA, MN 55987-6034
(507) 454-0000
(507) 454-6724
Mailing address
66 SHADY OAK CT, WINONA, MN 55987-6034
(507) 454-0000
(507) 454-6724
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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