Provider Demographics
NPI:1184669400
Name:STOUT, HEIDI RAE (PT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:RAE
Last Name:STOUT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9102 N MERIDIAN ST
Mailing Address - Street 2:STE 415
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1860
Mailing Address - Country:US
Mailing Address - Phone:317-581-1890
Mailing Address - Fax:317-581-2436
Practice Address - Street 1:9102 N MERIDIAN ST
Practice Address - Street 2:STE 415
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1860
Practice Address - Country:US
Practice Address - Phone:317-581-1890
Practice Address - Fax:317-581-2436
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005096A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist