Healthcare Provider Details

I. General information

NPI: 1134859689
Provider Name (Legal Business Name): KAYLA SARA HEUER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E STATE ST
SAINT CROIX FALLS WI
54024-4117
US

IV. Provider business mailing address

235 E STATE ST
SAINT CROIX FALLS WI
54024-4117
US

V. Phone/Fax

Practice location:
  • Phone: 715-483-3221
  • Fax: 715-483-0507
Mailing address:
  • Phone: 715-483-3221
  • Fax: 715-483-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0015058
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4149
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: