Provider Demographics
NPI:1942399704
Name:WISSEL, HEATHER L (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:WISSEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:SERMERSHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1106 E COUNTRYWOOD EST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9134
Mailing Address - Country:US
Mailing Address - Phone:812-357-5118
Mailing Address - Fax:
Practice Address - Street 1:1020 11TH ST # C
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2130
Practice Address - Country:US
Practice Address - Phone:812-547-7770
Practice Address - Fax:812-547-7784
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007768A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05007768AOtherPHYSICAL THERAPY LICENSE