Provider Demographics
NPI:1336996594
Name:HEISLER, ANGELA DAWN (PTA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DAWN
Last Name:HEISLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:OLIVET
Mailing Address - State:MI
Mailing Address - Zip Code:49076-9779
Mailing Address - Country:US
Mailing Address - Phone:517-667-4904
Mailing Address - Fax:
Practice Address - Street 1:417 CHURCH ST
Practice Address - Street 2:
Practice Address - City:OLIVET
Practice Address - State:MI
Practice Address - Zip Code:49076-9779
Practice Address - Country:US
Practice Address - Phone:517-667-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001909225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant