Provider Demographics
NPI:1891966834
Name:GREENWOOD, HEIDI VANDERWILDE (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:VANDERWILDE
Last Name:GREENWOOD
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 1:1011 S AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-2020
Mailing Address - Country:US
Mailing Address - Phone:509-458-4143
Mailing Address - Fax:
Practice Address - Street 1:1011 S AZALEA DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-2020
Practice Address - Country:US
Practice Address - Phone:509-458-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist