Provider Demographics
NPI:1144427345
Name:HELDT, AMY M (PTA)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:M
Last Name:HELDT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 168
Mailing Address - Street 2:
Mailing Address - City:FORT BRANCH
Mailing Address - State:IN
Mailing Address - Zip Code:47648-9655
Mailing Address - Country:US
Mailing Address - Phone:812-779-7696
Mailing Address - Fax:
Practice Address - Street 1:25 S BOEHNE CAMP RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-3101
Practice Address - Country:US
Practice Address - Phone:812-423-7468
Practice Address - Fax:812-423-7568
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003358A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155238Medicaid