Provider Demographics
NPI:1336341791
Name:HEIM, SHANNON KAY (CPTA)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:KAY
Last Name:HEIM
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:KS
Mailing Address - Zip Code:66536-1408
Mailing Address - Country:US
Mailing Address - Phone:785-844-2140
Mailing Address - Fax:
Practice Address - Street 1:2011 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1159
Practice Address - Country:US
Practice Address - Phone:785-456-7813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01779225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant