Individual
ANDREW CHARLES HEIDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1325 SAN MARCO BLVD STE 102, CREDENTIALING DEPARTMENT, JACKSONVILLE, FL 32207-8549
(904) 858-7045
(904) 858-7047
Mailing address
PO BOX 40767, CREDENTIALING DEPARTMENT, JACKSONVILLE, FL 32203-0767
(904) 376-3707
(904) 391-5807
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT21973
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00295808
RR MEDICARE
FL
Enumeration date
06/14/2005
Last updated
02/04/2015
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