Provider Demographics
NPI:1720112162
Name:OWENS, HEIDI KAY (PT)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:KAY
Last Name:OWENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 W WILSON AVE
Mailing Address - Street 2:UNIT 2A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6243
Mailing Address - Country:US
Mailing Address - Phone:773-412-3757
Mailing Address - Fax:773-506-2529
Practice Address - Street 1:1318 W WILSON AVE
Practice Address - Street 2:UNIT 2A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6243
Practice Address - Country:US
Practice Address - Phone:773-412-3757
Practice Address - Fax:773-506-2529
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics