Provider Demographics
NPI:1003017849
Name:RICHELMAN, HEATHER (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RICHELMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 CALVARY CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62916-2213
Mailing Address - Country:US
Mailing Address - Phone:618-426-3480
Mailing Address - Fax:
Practice Address - Street 1:900 N. WASHINGTON
Practice Address - Street 2:
Practice Address - City:DUQUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832
Practice Address - Country:US
Practice Address - Phone:618-542-2146
Practice Address - Fax:618-542-4756
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist