Provider Demographics
NPI:1750162376
Name:KERWIN, HEIDI W (PTA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:W
Last Name:KERWIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:M
Other - Last Name:WOLLSCHLEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:100 SLEEPY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4410
Mailing Address - Country:US
Mailing Address - Phone:585-350-8437
Mailing Address - Fax:
Practice Address - Street 1:100 SLEEPY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4410
Practice Address - Country:US
Practice Address - Phone:585-350-8437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004085-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant