Provider Demographics
NPI:1861764110
Name:HEIKKINEN, ANGELA MICHELE (PTA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELE
Last Name:HEIKKINEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH RANGE
Mailing Address - State:MI
Mailing Address - Zip Code:49963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 POPLAR ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1121
Practice Address - Country:US
Practice Address - Phone:906-482-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001810225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant