Provider Demographics
NPI:1275372773
Name:HEIGHWAY, KAILEY RYANNE (DPT)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:RYANNE
Last Name:HEIGHWAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAILEY
Other - Middle Name:RYANNE
Other - Last Name:WILLHELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6002 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-5614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6002 E 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-5614
Practice Address - Country:US
Practice Address - Phone:317-880-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012154A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist