Provider Demographics
NPI:1043582976
Name:HEILMAN, D'ANDRA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:D'ANDRA
Middle Name:LYNN
Last Name:HEILMAN
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 1:9760 MANDON RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-2949
Mailing Address - Country:US
Mailing Address - Phone:248-388-1362
Mailing Address - Fax:810-620-7389
Practice Address - Street 1:9760 MANDON RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-2949
Practice Address - Country:US
Practice Address - Phone:248-388-1362
Practice Address - Fax:810-620-7389
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6634225100000X
MI5501016732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist