Healthcare Provider Details

I. General information

NPI: 1487945101
Provider Name (Legal Business Name): HEATHER HEFFNER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12881 KNOTT ST STE 103
GARDEN GROVE CA
92841-3939
US

IV. Provider business mailing address

12881 KNOTT ST STE 103
GARDEN GROVE CA
92841-3939
US

V. Phone/Fax

Practice location:
  • Phone: 714-892-6828
  • Fax: 714-898-9720
Mailing address:
  • Phone: 714-892-6828
  • Fax: 714-898-9720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number37579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: