Mary Heitzig
Individual provider Active NPI Physical Therapist · Fieldon, IL
NPI 1366047607 · NPPES record last updated Dec 28, 2020
Key facts
- NPI
- 1366047607
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070025648 (IL)
- Practice address
- 17002 State Highway 16
Fieldon, IL 62031-1109 - Phone
- (618) 376-4102
- NPI assigned
- Dec 3, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070025648 | IL | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070025648 | IL | Yes |
Addresses
Primary practice location
17002 State Highway 16
Fieldon, IL 62031-1109
Mailing address
17002 State Highway 16
Fieldon, IL 62031-1109
Phone (618) 376-4102
Other providers in Fieldon, IL
All providers in Fieldon, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.