Basic Information
| Provider Information | |||||||||
| NPI: | 1033176540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOLKER | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | MS.PT, MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6825 OWEN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | LORETTO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553579713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635200579 | ||||||||
| FaxNumber: | 7635200355 | ||||||||
| Practice Location | |||||||||
| Address1: | 6825 OWEN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | LORETTO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553579713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635200579 | ||||||||
| FaxNumber: | 7635200355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6551 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 6400785 | 01 | MEDICA | OTHER | 86D31V0 | 01 | MN | BCBS MINNESOTA | OTHER | HP41182 | 01 | HEALTH PARTNERS | OTHER |