Provider Demographics
NPI:1104462811
Name:HEALD, ADELINE ROSE
Entity type:Individual
Prefix:
First Name:ADELINE
Middle Name:ROSE
Last Name:HEALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADDIE
Other - Middle Name:ROSE
Other - Last Name:HEALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:204 SCHWARTZ ST
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1133
Mailing Address - Country:US
Mailing Address - Phone:319-572-8996
Mailing Address - Fax:
Practice Address - Street 1:401 S BIRCH ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IA
Practice Address - Zip Code:52623-9613
Practice Address - Country:US
Practice Address - Phone:319-392-4259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096805225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant