Provider Demographics
NPI:1558486100
Name:EVANS, HEATHER LEIGH (PT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEIGH
Last Name:EVANS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEIGH
Other - Last Name:SCHULZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:668 SE BAYBERRY LN STE 105
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4366
Mailing Address - Country:US
Mailing Address - Phone:816-434-5180
Mailing Address - Fax:816-286-1112
Practice Address - Street 1:668 SE BAYBERRY LN STE 105
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4366
Practice Address - Country:US
Practice Address - Phone:816-434-5180
Practice Address - Fax:816-286-1112
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006013172225100000X
KS11-03551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006013172OtherSTATE LICENSE
KS11-03551OtherSTATE LICENSE