Healthcare Provider Details

I. General information

NPI: 1649365800
Provider Name (Legal Business Name): KELLY ANN HEYSINGER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4135 PENNSYLVANIA AVENUE
DUBUQUE IA
52002
US

IV. Provider business mailing address

4121 PENNSYLVANIA AVE
DUBUQUE IA
52002-2628
US

V. Phone/Fax

Practice location:
  • Phone: 563-583-4003
  • Fax: 563-583-4737
Mailing address:
  • Phone: 563-583-4003
  • Fax: 563-583-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-012082
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15112-24
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03142
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: