Individual
MICHAEL THOMAS HEISER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
4655 N PORT WASHINGTON RD, GLENDALE, WI 53212-1004
(414) 332-7475
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15815-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1234560627
—
WI
Enumeration date
06/10/2022
Last updated
06/08/2023
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