Provider Demographics
NPI:1649365800
Name:HEYSINGER, KELLY ANN (DPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:HEYSINGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2628
Mailing Address - Country:US
Mailing Address - Phone:563-583-4003
Mailing Address - Fax:563-583-4737
Practice Address - Street 1:4135 PENNSYLVANIA AVENUE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002
Practice Address - Country:US
Practice Address - Phone:563-583-4003
Practice Address - Fax:563-583-4737
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012082225100000X
WI15112-24225100000X
IA03142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA08370OtherBCBS PROVIDER #