Provider Demographics
NPI:1912260233
Name:HEARD, KATHY LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:HEARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 KATHLEEN RD
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832
Mailing Address - Country:US
Mailing Address - Phone:618-790-4116
Mailing Address - Fax:
Practice Address - Street 1:101 N. WALNUT ST.
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274
Practice Address - Country:US
Practice Address - Phone:618-357-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160001840225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant