Healthcare Provider Details

I. General information

NPI: 1093641011
Provider Name (Legal Business Name): RYLEE ANN HEIDLOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PKWY
HIGH POINT NC
27268-0002
US

IV. Provider business mailing address

1340 EDINGTON LN
MUNDELEIN IL
60060-2093
US

V. Phone/Fax

Practice location:
  • Phone: 336-841-9000
  • Fax:
Mailing address:
  • Phone: 224-358-7881
  • Fax: 224-358-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: