Provider Demographics
NPI:1174611461
Name:KIRCHOFF, HEATHER R (PT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:KIRCHOFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:R
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6960 E MUNDY BLVD
Mailing Address - Street 2:
Mailing Address - City:CELESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:47521-9692
Mailing Address - Country:US
Mailing Address - Phone:812-481-0055
Mailing Address - Fax:
Practice Address - Street 1:1020 11TH ST # C
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2130
Practice Address - Country:US
Practice Address - Phone:812-547-7770
Practice Address - Fax:812-547-7784
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
IN05005623A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05005623AOtherPHYSICAL THERAPIST LICENS