Provider Demographics
NPI:1962591776
Name:BLINKA, HEIDI INGE WIEDAMANN (LPT)
Entity type:Individual
Prefix:MRS
First Name:HEIDI INGE
Middle Name:WIEDAMANN
Last Name:BLINKA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 SCHOCALOG RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1027
Mailing Address - Country:US
Mailing Address - Phone:330-869-5922
Mailing Address - Fax:
Practice Address - Street 1:405 TALLMADGE RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3342
Practice Address - Country:US
Practice Address - Phone:330-920-6526
Practice Address - Fax:330-920-6528
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-05230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist