Provider Demographics
NPI:1679546246
Name:VANHEYSTE, PIA S (LPT)
Entity Type:Individual
Prefix:
First Name:PIA
Middle Name:S
Last Name:VANHEYSTE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9639 MONOLITH DR. NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114
Mailing Address - Country:US
Mailing Address - Phone:575-312-3275
Mailing Address - Fax:
Practice Address - Street 1:7920 CARMEL AVE NE
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2966
Practice Address - Country:US
Practice Address - Phone:505-797-5505
Practice Address - Fax:505-797-5510
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM23033266Medicaid
NM23033266Medicaid