Healthcare Provider Details

I. General information

NPI: 1538837232
Provider Name (Legal Business Name): ANDREW M HEFNER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 ARNOLD DR
LITTLE ROCK AFB AR
72099-7479
US

IV. Provider business mailing address

1090 ARNOLD DR
LITTLE ROCK AFB AR
72099-7479
US

V. Phone/Fax

Practice location:
  • Phone: 501-987-3080
  • Fax:
Mailing address:
  • Phone: 501-987-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5029
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: