Heidi Louisa Gillis, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2708-19 Issued in WI

Practice address

958 Foote St
Seymour, WI 54165-1044

Phone

(920) 562-0621

NPI assigned

Oct 17, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1841701893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1132 HIGHVIEW LN",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042222",
            "telephone_number": "920-562-0621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "958 FOOTE ST",
            "city": "SEYMOUR",
            "state": "WI",
            "postal_code": "541651044",
            "telephone_number": "920-562-0621"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1132 Highview Ln",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543042222",
            "country_code": "US",
            "telephone_number": "920-562-0621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLIS",
        "first_name": "HEIDI",
        "middle_name": "LOUISA",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-17",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "2708-19",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Seymour, WI
• Providers in Seymour, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.