Provider Demographics
NPI:1932293826
Name:KANEALY, HEIDI (PT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:KANEALY
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 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:319-364-0300
Mailing Address - Fax:319-364-4043
Practice Address - Street 1:3720 QUEEN CT SW
Practice Address - Street 2:SUITE 1
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-4735
Practice Address - Country:US
Practice Address - Phone:319-364-0300
Practice Address - Fax:319-364-4043
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665026Medicaid
IA0429076Medicaid
IA0665026Medicaid
IA166502Medicare PIN