Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1139970 | TX |
NPI | 1073520888 |
---|---|
Provider Name | Kimberly Heller |
First Address | Austin, TX 78727-0262 |
Second Address | Austin, TX 78758-5260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8T4929 | BLUE CROSS & BLUE SHIELD (01) | TX |