Basic Information
| Provider Information | |||||||||
| NPI: | 1851591440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEYNS | ||||||||
| FirstName: | SELENA | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 855 SPRINGDALE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193412852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106447824 | ||||||||
| FaxNumber: | 6106449065 | ||||||||
| Practice Location | |||||||||
| Address1: | 1330 QUAIL LAKE LOOP STE 100 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809064651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195790230 | ||||||||
| FaxNumber: | 7195790277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2007 | ||||||||
| LastUpdateDate: | 05/11/2011 | ||||||||
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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 | 9603 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 14407761 | 05 | CO | MEDICAID | P00424869 | 01 | CO | RAILROAD MEDICARE | OTHER |