Healthcare Provider Details

I. General information

NPI: 1215944962
Provider Name (Legal Business Name): JONATHAN P HEGEMIER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E MAIN ST STE B
WOODVILLE OH
43469-1209
US

IV. Provider business mailing address

108 E MAIN ST
WOODVILLE OH
43469-1237
US

V. Phone/Fax

Practice location:
  • Phone: 419-849-2900
  • Fax: 419-849-2901
Mailing address:
  • Phone: 419-849-2900
  • Fax: 419-849-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT05091
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: