Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | P4755 | NC |
N | 2251C2600X | Cardiopulmonary | P4755 | NC |
N | 2251G0304X | Physical Therapist - Geriatrics | P4755 | NC |
N | 2251N0400X | Physical Therapist - Neurology | P4755 | NC |
NPI | 1972950988 |
---|---|
Provider Name | Amanda Gale Heermans |
First Address | Omaha, NE 68154-5260 |
Second Address | Omaha, NE 68154-5260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2016 |
Last Update Date | 19/05/2016 |