Provider Demographics
NPI:1508059387
Name:HEYNE-LINDHOLM, PHYLLIS ANN (PT)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ANN
Last Name:HEYNE-LINDHOLM
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 1:225 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4417
Mailing Address - Country:US
Mailing Address - Phone:701-323-8072
Mailing Address - Fax:
Practice Address - Street 1:225 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4417
Practice Address - Country:US
Practice Address - Phone:701-323-8072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND334225100000X
SD0850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist