Basic Information
| Provider Information | |||||||||
| NPI: | 1912230947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEIDEMANN | ||||||||
| FirstName: | KERRI | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PHYSICAL THERAPIST | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHRAND | ||||||||
| OtherFirstName: | KERRI | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PHYSICAL THERAPIST | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6480 HARRISON AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452477961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133547650 | ||||||||
| FaxNumber: | 5133547651 | ||||||||
| Practice Location | |||||||||
| Address1: | 6480 HARRISON AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452477961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133547777 | ||||||||
| FaxNumber: | 5133547778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2009 | ||||||||
| LastUpdateDate: | 10/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT05853 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.