Provider Demographics
NPI:1417110743
Name:RIEKEN, HEATHER (LPTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RIEKEN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:IA
Mailing Address - Zip Code:50611-9702
Mailing Address - Country:US
Mailing Address - Phone:641-425-8673
Mailing Address - Fax:
Practice Address - Street 1:1402 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSON
Practice Address - State:IA
Practice Address - Zip Code:50563-5160
Practice Address - Country:US
Practice Address - Phone:712-469-3908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00833225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant