Provider Demographics
NPI:1871004614
Name:HENDON, HEIDI (PTA)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:HENDON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:HABERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13744 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA STATION
Mailing Address - State:OH
Mailing Address - Zip Code:44028-8936
Mailing Address - Country:US
Mailing Address - Phone:440-453-5057
Mailing Address - Fax:
Practice Address - Street 1:13744 E RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA STATION
Practice Address - State:OH
Practice Address - Zip Code:44028-8936
Practice Address - Country:US
Practice Address - Phone:440-453-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08033208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation