Healthcare Provider Details

I. General information

NPI: 1770939597
Provider Name (Legal Business Name): KRISTIN MARIE HEYRMAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N3435 FOUR SEASONS DR
IRON MOUNTAIN MI
49801-9465
US

IV. Provider business mailing address

N3435 FOUR SEASONS DR
IRON MOUNTAIN MI
49801-9465
US

V. Phone/Fax

Practice location:
  • Phone: 720-724-3884
  • Fax: 906-774-2902
Mailing address:
  • Phone: 720-724-3884
  • Fax: 906-774-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501017473
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: