Provider Demographics
NPI:1669513057
Name:PILCHER, HEATHER RENEE (PTA, MSE, ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RENEE
Last Name:PILCHER
Suffix:
Gender:F
Credentials:PTA, MSE, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SE 9TH ST.
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219
Mailing Address - Country:US
Mailing Address - Phone:641-621-0230
Mailing Address - Fax:
Practice Address - Street 1:308 SE 9TH ST.
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219
Practice Address - Country:US
Practice Address - Phone:641-621-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001454225200000X
IA005812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer