Basic Information
| Provider Information | |||||||||
| NPI: | 1285189589 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ARDNER | ||||||||
| FirstName: | HEATHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9432 OBRIAN AVE NE | ||||||||
| Address2: | |||||||||
| City: | OTSEGO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553305105 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 SAINT ANDREWS CT | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560018659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073885437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2016 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 10422 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.