Basic Information
| Provider Information | |||||||||
| NPI: | 1194901389 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HELLER | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 W BELTLINE HWY | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537132318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082946464 | ||||||||
| FaxNumber: | 6082886496 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W BELTLINE HWY | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082946464 | ||||||||
| FaxNumber: | 6082886496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2008 | ||||||||
| LastUpdateDate: | 06/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2984-024 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7734 | 01 | WI | DEAN HEALTH INSURANCE | OTHER |