MEDICARE: MRS. GRACE HECKMAN MS, ATC, LAT, CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	RT001767A	PA

General Provider Information

NPI Number	:	1053572602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRACE HECKMAN MS, ATC, LAT, CSCS

Provider Business Mailing Address
First Line	:	205 SYCAMORE RD
Second Line	:
City	:	READING
State	:	PA
Zip	:	19611-1535
Country	:	US
Telephone Number	:	484-794-5680
Fax Number	:

Provider Business Practice Location Address
First Line	:	4897 N TWIN VALLEY RD
Second Line	:
City	:	ELVERSON
State	:	PA
Zip	:	19520-9340
Country	:	US
Telephone Number	:	610-286-8577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	11/08/2012

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