Heather Fenner, PTA
Individual provider Active NPI Physical Therapy Assistant · Dickeyville, WI
NPI 1508560756 · NPPES record last updated Mar 29, 2023
Key facts
- NPI
- 1508560756
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 083753 (IA)
- Practice address
- 159 S Main St
Dickeyville, WI 53808-6836 - Phone
- (608) 723-9772
- NPI assigned
- Mar 29, 2023
- 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)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 083753 | IA | MD | Physical Therapy Assistant |
| 2474 | WI | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2474 | WI | |
| Physical Therapy Assistant | 225200000X | 083753 | IA | Yes |
Addresses
Primary practice location
159 S Main St
Dickeyville, WI 53808-6836
Mailing address
PO Box 342
Dickeyville, WI 53808-0342
Phone (608) 723-9772
Other names
- Heather White
Other providers in Dickeyville, WI
- Dickeyville Health Services Incorporated
- Dickeyville Rescue Squad Inc
- Amy Fields
- Tammy Jean Leeser
- Ben A Vogt
All providers in Dickeyville, WI · Physical Therapy Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2023. 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.