Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1061448 | TX |
N | 2251P0200X | Physical Therapist - Pediatrics | 1061448 | TX |
NPI | 1063828341 |
---|---|
Provider Name | Shelly Heilman |
First Address | Sierra Vista, AZ 85650-6629 |
Second Address | Corpus Christi, TX 78404-2833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 07/07/2014 |