Individual
HEIDI PANGBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18285 E 10 MILE RD, STE.100, ROSEVILLE, MI 48066-5802
(586) 774-5774
Mailing address
524 HOLLYWOOD AVE, GROSSE POINTE WOODS, MI 48236-1319
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501005887
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650H229330
BCBS
MI
Enumeration date
07/26/2006
Last updated
07/20/2011
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