Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 7479 | OH |
NPI | 1043646086 |
---|---|
Provider Name | Mrs. Heidi Marie Schauss |
First Address | Avon Lake, OH 44012-1216 |
Second Address | Westlake, OH 44145-1477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2013 |
Last Update Date | 23/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H094130 | GROUP PROVIDER NUMBER (01) |