Provider Demographics
NPI:1932616505
Name:LENOX, HEATHER DAWNE (PTA)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:DAWNE
Last Name:LENOX
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DAWNE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:NE
Mailing Address - Zip Code:68715-0068
Mailing Address - Country:US
Mailing Address - Phone:402-992-2620
Mailing Address - Fax:
Practice Address - Street 1:2000 WESLEYAN BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-9340
Practice Address - Country:US
Practice Address - Phone:605-718-5742
Practice Address - Fax:605-718-5742
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1188208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation