Provider Demographics
NPI:1427578087
Name:HECK, KAYSHA (PT)
Entity Type:Individual
Prefix:MRS
First Name:KAYSHA
Middle Name:
Last Name:HECK
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:PO BOX 2005
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-2005
Mailing Address - Country:US
Mailing Address - Phone:425-218-7178
Mailing Address - Fax:
Practice Address - Street 1:1090 S HWY 89
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-733-5577
Practice Address - Fax:307-733-5505
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist