Provider Demographics
NPI:1508962028
Name:CHRISTLIEB, HEATHER D (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:D
Last Name:CHRISTLIEB
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 1:312 E DUPONT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825
Mailing Address - Country:US
Mailing Address - Phone:260-483-1010
Mailing Address - Fax:260-483-1011
Practice Address - Street 1:312 E DUPONT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-483-1010
Practice Address - Fax:260-483-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007314A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000536911OtherANTHEM PIN
IN000000536911OtherANTHEM PIN