Healthcare Provider Details

I. General information

NPI: 1003184110
Provider Name (Legal Business Name): PHILLIP HEFNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 SUMMIT CROSSING PL
GASTONIA NC
28054-2192
US

IV. Provider business mailing address

7446 HENRY RD
VALE NC
28168-7475
US

V. Phone/Fax

Practice location:
  • Phone: 704-867-2333
  • Fax:
Mailing address:
  • Phone: 828-244-7429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3457
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: