Provider Demographics
NPI:1609858687
Name:COREY, HEATHER ANN (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:COREY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:TONNIGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:4110 S 144TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1013
Practice Address - Country:US
Practice Address - Phone:402-861-6683
Practice Address - Fax:402-861-6689
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0586404Medicaid
NE06526OtherBLUE CROSS BLUE SHIELD
IA0586404Medicaid
NE06526OtherBLUE CROSS BLUE SHIELD
NEP00182512Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER