MEDICARE: LAURA M HEJTMANEK PT DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	03949	IA
2	225100000X	Physical Therapist	3949	IA

General Provider Information

NPI Number	:	1225193345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA M HEJTMANEK PT DPT

Provider Business Mailing Address
First Line	:	2001 WESTOWN PKWY
Second Line	:	STE 107
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-1540
Country	:	US
Telephone Number	:	515-440-3439
Fax Number	:	515-440-3832

Provider Business Practice Location Address
First Line	:	516 NILE KINNICK DR. SOUTH
Second Line	:	STE B
City	:	ADEL
State	:	IA
Zip	:	50003-1831
Country	:	US
Telephone Number	:	515-993-5599
Fax Number	:	515-993-1964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	09/28/2010

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