=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740687573
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIN ANNE VANDE HEI DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2014
-----------------------------------------------------
Last Update Date | 02/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1109 W CLAIREMONT AVE
-----------------------------------------------------
City | EAU CLAIRE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54701-6105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-717-4338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13108 8TH ST
-----------------------------------------------------
City | OSSEO
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54758-7679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-769-7332
-----------------------------------------------------
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 | 12712-24
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------