Provider Demographics
NPI:1740210376
Name:DUBOIS, HEATHER SUSAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:SUSAN
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:KINSLEY
Mailing Address - State:KS
Mailing Address - Zip Code:67547-1106
Mailing Address - Country:US
Mailing Address - Phone:620-659-3753
Mailing Address - Fax:
Practice Address - Street 1:1401 CHERRY LN
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3152
Practice Address - Country:US
Practice Address - Phone:620-792-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist