Individual
JEFFREY D HEADDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
639 S WALKER ST STE A, BLOOMINGTON, IN 47403-2124
(317) 455-1064
(317) 455-1204
Mailing address
512 TIMBER RIDGE RD, SPENCER, IN 47460-5981
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05004322A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200488270
—
IN
Enumeration date
06/17/2005
Last updated
07/02/2024
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