Healthcare Provider Details

I. General information

NPI: 1447090162
Provider Name (Legal Business Name): KRISTA M HEFFNER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WALNUT ST STE 647
PHILADELPHIA PA
19106-3323
US

IV. Provider business mailing address

720 N 16TH ST APT 2
PHILADELPHIA PA
19130-2283
US

V. Phone/Fax

Practice location:
  • Phone: 215-867-8753
  • Fax:
Mailing address:
  • Phone: 814-308-3812
  • 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: