Provider Demographics
NPI:1952911927
Name:HEISE, KAYLEIGH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KAYLEIGH
Middle Name:
Last Name:HEISE
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 1:40 COMMERCE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:WV
Mailing Address - Zip Code:26501-3952
Mailing Address - Country:US
Mailing Address - Phone:304-292-7535
Mailing Address - Fax:
Practice Address - Street 1:40 COMMERCE DR STE 101
Practice Address - Street 2:
Practice Address - City:WESTOVER
Practice Address - State:WV
Practice Address - Zip Code:26501-3952
Practice Address - Country:US
Practice Address - Phone:304-292-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001889225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant