Provider Demographics
NPI:1184692865
Name:HEANEY, SUSAN MARIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:HEANEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:KLUTHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 S 72ND ST
Mailing Address - Street 2:STE 302
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1743
Mailing Address - Country:US
Mailing Address - Phone:402-391-2635
Mailing Address - Fax:402-391-0326
Practice Address - Street 1:1910 S 72ND ST
Practice Address - Street 2:STE 302
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1743
Practice Address - Country:US
Practice Address - Phone:402-391-2635
Practice Address - Fax:402-391-0326
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE2106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39567OtherBCBS
NE39567OtherBCBS