Healthcare Provider Details

I. General information

NPI: 1013210871
Provider Name (Legal Business Name): HEFFERNAN PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 STATE AVE STE E
PANAMA CITY FL
32405-4379
US

IV. Provider business mailing address

2335 STATE AVE STE E
PANAMA CITY FL
32405-4379
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-1992
  • Fax: 850-769-4808
Mailing address:
  • Phone: 850-763-1992
  • Fax: 850-769-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7288
License Number StateFL

VIII. Authorized Official

Name: MRS. REBECCA HEFFERNAN
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 850-769-1992