Healthcare Provider Details

I. General information

NPI: 1598316515
Provider Name (Legal Business Name): CHRISTOPHER HEFFERNAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OAKLEY SEAVER DR STE 11
CLERMONT FL
34711-1974
US

IV. Provider business mailing address

925 OASIS PALM CIR APT 2408
OCOEE FL
34761-3345
US

V. Phone/Fax

Practice location:
  • Phone: 352-241-0347
  • Fax:
Mailing address:
  • Phone: 203-536-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: