Provider Demographics
NPI:1730710724
Name:ZWICK, HEIDI MARIE (ATC)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:MARIE
Last Name:ZWICK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 CIRCLE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1350
Mailing Address - Country:US
Mailing Address - Phone:859-380-7078
Mailing Address - Fax:606-539-4126
Practice Address - Street 1:6790 COLLEGE STATION DRIVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769
Practice Address - Country:US
Practice Address - Phone:606-521-9442
Practice Address - Fax:606-539-4126
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT16432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer