Provider Demographics
NPI:1346598430
Name:HEILMAN, AMANDA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:HEILMAN
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 1:200 W RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588
Mailing Address - Country:US
Mailing Address - Phone:712-213-8184
Mailing Address - Fax:
Practice Address - Street 1:200 W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-2449
Practice Address - Country:US
Practice Address - Phone:712-213-8184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004904225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant