Provider Demographics
NPI:1114320009
Name:PENSINGER, HEIDI LYN (MS, AT, ATC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYN
Last Name:PENSINGER
Suffix:
Gender:F
Credentials:MS, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69083 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-9764
Mailing Address - Country:US
Mailing Address - Phone:269-767-1051
Mailing Address - Fax:
Practice Address - Street 1:69083 PALMER DR
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-9764
Practice Address - Country:US
Practice Address - Phone:269-767-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010013352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer