Individual ProviderHeather Ann DeforeestPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address4921 E 21st St N, Wichita, KS 67208-1602(316) 681-3204PECOS EnrollmentBased on the most recent information from CMS, provider Heather Ann Deforeest does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1376733360Provider TypeIndividualFull NameDeforeest, Heather AnnCredentialRPTGenderFemaleSole ProprietorNoEnumeration Date7/26/2007Last Updated2/1/2011Contact InformationPractice LocationPractice Address4921 E 21st St N, Wichita, KS 67208-1602Phone(316) 681-3204Fax(316) 681-0541Mailing LocationMailing Address4921 E 21st St N, Wichita, KS 67208-1602Phone(316) 681-3204FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense11-03582KansasProvider IdentifiersIDDescriptionIssuerID200316360BDescriptionMedicaidIssuerUnlistedKansasID115161DescriptionOtherIssuerBLUE CROSS BLUE SHIELDKansas