MEDICARE: MRS. HEIDI INGE WIEDAMANN BLINKA LPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	OH-05230	OH

General Provider Information

NPI Number	:	1962591776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEIDI INGE WIEDAMANN BLINKA LPT

Provider Business Mailing Address
First Line	:	317 SCHOCALOG RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-1027
Country	:	US
Telephone Number	:	330-869-5922
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 TALLMADGE RD
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-3342
Country	:	US
Telephone Number	:	330-920-6526
Fax Number	:	330-920-6528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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