=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326114687
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAIL M. HEINECKE P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6800 N 76TH ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53223-5002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-353-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 581 KREUSER RDG
-----------------------------------------------------
City | COLGATE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53017-9793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-628-1712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1857-024
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------