Provider Demographics
NPI:1740353648
Name:JANNENGA, HEIDI DOUNE (PT, ATC)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:DOUNE
Last Name:JANNENGA
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:DOUNE
Other - Last Name:WUTSCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, ATC
Mailing Address - Street 1:1025 E BROADWAY RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1599
Mailing Address - Country:US
Mailing Address - Phone:480-829-0217
Mailing Address - Fax:
Practice Address - Street 1:1025 E BROADWAY RD
Practice Address - Street 2:STE. 100
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1599
Practice Address - Country:US
Practice Address - Phone:480-829-0217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036551Medicare ID - Type Unspecified