Individual
BRIAN T HEATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
23108 LANSING LN, MIDDLETON, ID 83644-5630
(208) 484-0096
Mailing address
23108 LANSING LN, MIDDLETON, ID 83644-5630
(208) 484-0096
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3890
OR
Other
Enumeration date
01/05/2007
Last updated
07/08/2007
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