Provider Demographics
NPI:1366851958
Name:HEISERMAN, KATLYN
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:HEISERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 QUONSET AVE
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:IA
Mailing Address - Zip Code:52329-9780
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3007 QUONSET AVE
Practice Address - Street 2:
Practice Address - City:ROWLEY
Practice Address - State:IA
Practice Address - Zip Code:52329-9780
Practice Address - Country:US
Practice Address - Phone:563-920-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist