Provider Demographics
NPI:1467669465
Name:HEITZIG, KIMBERLY ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:HEITZIG
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 1:1679 700TH AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-9607
Mailing Address - Country:US
Mailing Address - Phone:217-732-2686
Mailing Address - Fax:217-732-3101
Practice Address - Street 1:315 8TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-2671
Practice Address - Country:US
Practice Address - Phone:217-732-2161
Practice Address - Fax:217-732-3101
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70.011231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist