Provider Demographics
NPI:1245635275
Name:HELINE, LAURA (MAT, ATC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HELINE
Suffix:
Gender:F
Credentials:MAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 UNIVERSITY BLVD
Mailing Address - Street 2:ATHLETIC TRAINING
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-3534
Mailing Address - Country:US
Mailing Address - Phone:812-464-1955
Mailing Address - Fax:812-465-1129
Practice Address - Street 1:8600 UNIVERSITY BLVD
Practice Address - Street 2:ATHLETIC TRAINING
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-3534
Practice Address - Country:US
Practice Address - Phone:812-464-1955
Practice Address - Fax:812-465-1129
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001850A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer