Provider Demographics
NPI:1740687573
Name:VANDE HEI, KRISTIN ANNE (DPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANNE
Last Name:VANDE HEI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ANNE
Other - Last Name:MELTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:13108 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:WI
Mailing Address - Zip Code:54758-7679
Mailing Address - Country:US
Mailing Address - Phone:608-769-7332
Mailing Address - Fax:
Practice Address - Street 1:1109 W CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6105
Practice Address - Country:US
Practice Address - Phone:715-717-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12712-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist