Individual
HEATHER ANN DEFOREEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
4921 E 21ST ST N, WICHITA, KS 67208-1602
(316) 681-3204
(316) 681-0541
Mailing address
4921 E 21ST ST N, WICHITA, KS 67208-1602
(316) 681-3204
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-03582
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115161
BLUE CROSS BLUE SHIELD
KS
05
—
200316360B
—
KS
Enumeration date
07/26/2007
Last updated
02/01/2011
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