Provider Demographics
NPI:1215935341
Name:KREIZENBECK, HEATHER A (PT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:KREIZENBECK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6540
Mailing Address - Country:US
Mailing Address - Phone:360-647-0444
Mailing Address - Fax:360-650-1497
Practice Address - Street 1:306 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6540
Practice Address - Country:US
Practice Address - Phone:360-647-0444
Practice Address - Fax:360-650-1497
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8321267Medicaid
WA0152198OtherLABOR AND INDUSTRIES
WA0152198OtherLABOR AND INDUSTRIES
WA8321267Medicaid
GAB23202Medicare PIN
P36131Medicare UPIN