Provider Demographics
NPI:1568954527
Name:ADAMEK, HEIDI LYNN (PT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:ADAMEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:LYNN
Other - Last Name:GOEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:261 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2495
Mailing Address - Country:US
Mailing Address - Phone:313-745-1055
Mailing Address - Fax:
Practice Address - Street 1:261 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist