Provider Demographics
NPI:1750599353
Name:HEATH, NOELEEN (PT)
Entity type:Individual
Prefix:MS
First Name:NOELEEN
Middle Name:
Last Name:HEATH
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 1:2410 CARLYLE DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2216
Mailing Address - Country:US
Mailing Address - Phone:269-383-1021
Mailing Address - Fax:269-353-6565
Practice Address - Street 1:5364 GREEN MEADOW RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1266
Practice Address - Country:US
Practice Address - Phone:269-353-6565
Practice Address - Fax:269-353-6565
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP19701Medicare ID - Type UnspecifiedPT
MIP19700001Medicare ID - Type UnspecifiedPT