Provider Demographics
NPI:1780309898
Name:NIEDZWIECKI, HEATHER MARIE (DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:NIEDZWIECKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MINGES CREEK PL
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4201
Mailing Address - Country:US
Mailing Address - Phone:269-979-6365
Mailing Address - Fax:
Practice Address - Street 1:75 MINGES CREEK PL
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4201
Practice Address - Country:US
Practice Address - Phone:269-979-6365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist