Provider Demographics
NPI:1386956902
Name:WULFF PLUMB GRAHAM, HEIDI L (DPT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:WULFF PLUMB GRAHAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:L
Other - Last Name:WULFF PLUMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10355 N LA CANADA DR STE 125
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-7307
Practice Address - Country:US
Practice Address - Phone:520-822-8640
Practice Address - Fax:520-822-8641
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
AZLPT-31259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00931576OtherMEDICARE RAILROAD
ILP00875195OtherMEDICARE RAILROAD
IL216859046Medicare PIN
ILP00875195OtherMEDICARE RAILROAD
IL202845226Medicare PIN