Provider Demographics
NPI:1689126401
Name:MUELLER, HEIDI (PT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:MUELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:TANIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4523 SILVER VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-8975
Mailing Address - Country:US
Mailing Address - Phone:231-313-2729
Mailing Address - Fax:231-922-0382
Practice Address - Street 1:1650 BARLOW ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4721
Practice Address - Country:US
Practice Address - Phone:231-941-3100
Practice Address - Fax:231-922-0382
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501007466OtherLICENSE NUMBER