Provider Demographics
NPI:1962416826
Name:HEIJSELAAR-KILIAN, DINA (PT)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:HEIJSELAAR-KILIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:HAARLEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:5587 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2695
Practice Address - Country:US
Practice Address - Phone:219-887-9021
Practice Address - Fax:219-887-9022
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005302A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01300084OtherRAILROAD MEDICARE
INP01300084OtherRAILROAD MEDICARE