Provider Demographics
NPI:1659740892
Name:FLEUCHAUS, HEIKE (PTA)
Entity Type:Individual
Prefix:MS
First Name:HEIKE
Middle Name:
Last Name:FLEUCHAUS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E PONDEROSA PKWY APT 213
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3383
Mailing Address - Country:US
Mailing Address - Phone:262-719-5201
Mailing Address - Fax:
Practice Address - Street 1:1201 E PONDEROSA PKWY APT 213
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3383
Practice Address - Country:US
Practice Address - Phone:262-719-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11812A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant