MEDICARE: DR. MARK C HEDETNIEMI DPT

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	2251X0800X	Orthopedic Physical Therapist	J1-0001757	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780841866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK C HEDETNIEMI DPT

Provider Business Mailing Address
First Line	:	232 MITCHELL ST
Second Line	:	SUITE 101
City	:	MILLSBORO
State	:	DE
Zip	:	19966-9412
Country	:	US
Telephone Number	:	302-934-1500
Fax Number	:	302-934-6628

Provider Business Practice Location Address
First Line	:	232 MITCHELL ST
Second Line	:	SUITE 101
City	:	MILLSBORO
State	:	DE
Zip	:	19966-9412
Country	:	US
Telephone Number	:	302-934-1500
Fax Number	:	302-934-6628

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

Provider Enumeration Date	:	05/17/2008
Last Update Date	:	05/17/2008

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