Basic Information
| Provider Information | |||||||||
| NPI: | 1245209808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEISSERER | ||||||||
| FirstName: | MEGGEN | ||||||||
| MiddleName: | SMILEY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| OtherLastName: | SMILEY | ||||||||
| OtherFirstName: | MEGGEN | ||||||||
| OtherMiddleName: | BETH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 2650 | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750198650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727242400 | ||||||||
| FaxNumber: | 9727242495 | ||||||||
| Practice Location | |||||||||
| Address1: | 731 E SOUTHLAKE BLVD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760926377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174428600 | ||||||||
| FaxNumber: | 8174428603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 04/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1142198 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.