Provider Demographics
NPI:1396852778
Name:KAPITZ, HEATHER M (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:KAPITZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:CLOUTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2646
Mailing Address - Country:US
Mailing Address - Phone:715-842-1700
Mailing Address - Fax:715-842-1744
Practice Address - Street 1:1415 MERRILL AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-842-1700
Practice Address - Fax:715-842-1744
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
9990-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40433200Medicaid
WI000281633Medicare PIN