Provider Demographics
NPI:1063891778
Name:WODZIAK, HEATHER L (PT, DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:WODZIAK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 LANCASTER LN
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-7555
Mailing Address - Country:US
Mailing Address - Phone:630-985-6072
Mailing Address - Fax:
Practice Address - Street 1:1439 LANCASTER LN
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-7555
Practice Address - Country:US
Practice Address - Phone:630-985-6072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.011521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist