Provider Demographics
NPI:1689292104
Name:HEAKINS, KAILEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:HEAKINS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-0208
Mailing Address - Country:US
Mailing Address - Phone:724-766-3406
Mailing Address - Fax:
Practice Address - Street 1:1120 S CALUMET RD STE 3
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3286
Practice Address - Country:US
Practice Address - Phone:219-983-9675
Practice Address - Fax:219-983-9681
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013921A225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist