Provider Demographics
NPI:1275925323
Name:HEIDELBERGER, KARIN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:
Last Name:HEIDELBERGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 M28 EAST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49849
Mailing Address - Country:US
Mailing Address - Phone:906-273-1525
Mailing Address - Fax:
Practice Address - Street 1:1001 M 28 E
Practice Address - Street 2:SUITE 8
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9322
Practice Address - Country:US
Practice Address - Phone:906-273-1525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist