Healthcare Provider Details

I. General information

NPI: 1053514026
Provider Name (Legal Business Name): MARCY R HEUER PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19525 W NORTH AVENUE FRANCISCAN WOODS
BROOKFIELD WI
53045
US

IV. Provider business mailing address

17814 W ROOSEVELT AVE
NEW BERLIN WI
53146
US

V. Phone/Fax

Practice location:
  • Phone: 262-785-1114
  • Fax: 262-780-3805
Mailing address:
  • Phone: 262-366-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4574024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: