Healthcare Provider Details

I. General information

NPI: 1508337668
Provider Name (Legal Business Name): MICHAEL HEGARTY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HAMILTON ST STE 211
PHILADELPHIA PA
19130-3814
US

IV. Provider business mailing address

475 ALLENDALE RD STE 206
KING OF PRUSSIA PA
19406-1431
US

V. Phone/Fax

Practice location:
  • Phone: 215-383-0220
  • Fax: 215-383-0221
Mailing address:
  • Phone: 610-270-0370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: