Provider Demographics
NPI:1184948903
Name:VAN METER, HEIDI L (PTA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:VAN METER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7176 E 1000 N
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-7002
Mailing Address - Country:US
Mailing Address - Phone:574-278-6519
Mailing Address - Fax:
Practice Address - Street 1:7176 E 1000 N
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-7002
Practice Address - Country:US
Practice Address - Phone:574-278-6519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001972A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant