Active NPI
Heather Ann Deforeest, RPT
- Physical Therapist
- Wichita, KS
National Provider Identifier
1376733360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11-03582
- Practice address
- 4921 E 21St St N
Wichita, KS 67208-1602 - Phone
- (316) 681-3204
- Fax
- (316) 681-0541
- NPI assigned
- Jul 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11-03582 | KS | Primary |
Addresses
Primary practice location
4921 E 21St St N
Wichita, KS 67208-1602
Mailing address
4921 E 21St St N
Wichita, KS 67208-1602
Phone (316) 681-3204
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200316360B | Medicaid | KS | |
| 115161 | Other | KS | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11-03582 | KS | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Erin Is Hope Foundation Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Speech-Language Pathologist
- Wichita, KS
- NPI 1780638999
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296518400000",
"number": "1376733360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4921 E 21ST ST N",
"city": "WICHITA",
"state": "KS",
"postal_code": "672081602",
"telephone_number": "316-681-3204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4921 E 21ST ST N",
"city": "WICHITA",
"state": "KS",
"postal_code": "672081602",
"telephone_number": "316-681-3204",
"fax_number": "316-681-0541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEFOREEST",
"first_name": "HEATHER",
"middle_name": "ANN",
"credential": "RPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-26",
"last_updated": "2011-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KS",
"license": "11-03582",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200316360B",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "115161",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.