Healthcare Provider Details

I. General information

NPI: 1942569504
Provider Name (Legal Business Name): JENNIFER R HEFFERNAN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6521 N ANDREWS AVE
FORT LAUDERDALE FL
33309-2131
US

IV. Provider business mailing address

11945 ATLANTIC CIR
BOCA RATON FL
33428-5607
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-6301
  • Fax:
Mailing address:
  • Phone: 561-853-4980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 15734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: