Provider Demographics
NPI:1003070707
Name:HEIN, ANNE MARIE (PT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:HEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3486 GRAND MEADOWS XING
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-9656
Mailing Address - Country:US
Mailing Address - Phone:920-967-1767
Mailing Address - Fax:
Practice Address - Street 1:3101 S PACKERLAND DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313
Practice Address - Country:US
Practice Address - Phone:920-592-3845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3367024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist