Provider Demographics
NPI:1093380107
Name:HEIBY, AMY E (ATC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:HEIBY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELISE LEFGREN
Other - Last Name:HEIBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:51722 QUINCE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-9639
Mailing Address - Country:US
Mailing Address - Phone:317-292-5357
Mailing Address - Fax:
Practice Address - Street 1:54515 STATE ROAD 933 NORTH
Practice Address - Street 2:
Practice Address - City:NOTRE DAME
Practice Address - State:IN
Practice Address - Zip Code:46556-4655
Practice Address - Country:US
Practice Address - Phone:574-239-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001586A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer