Provider Demographics
NPI:1124004049
Name:JOLLIFF, HEIDI M (MPT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:M
Last Name:JOLLIFF
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45839-0239
Mailing Address - Country:US
Mailing Address - Phone:419-422-5526
Mailing Address - Fax:419-422-5562
Practice Address - Street 1:1725 WESTERN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1345
Practice Address - Country:US
Practice Address - Phone:419-422-5526
Practice Address - Fax:419-422-5562
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT10484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1442035OtherBWC
OH2527699Medicaid
OH2527699Medicaid
OH9313985Medicare PIN