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General NPI Number Information
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NPI Number | 1942442389
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Entity Type | Individual
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Provider Name | HEATHER WONDERLICH P.T.
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Gender | Female
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 1804 HILLCREST DR
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City | BELLEVUE
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State | NE
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Zip | 68005-3663
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Country | US
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Telephone | 402-650-8954
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Fax |
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Provider Business Mailing Address
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Address Line | 13616 CALIFORNIA ST STE 100
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City | OMAHA
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State | NE
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Zip | 68154-5336
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Country | US
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Telephone | 402-496-0404
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Fax | 402-496-7766
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2729
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License Number State | NE
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