Healthcare Provider Details

I. General information

NPI: 1457115750
Provider Name (Legal Business Name): MARILYN HEKRDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320B CHARLES H DIMMOCK PKWY STE 6
COLONIAL HEIGHTS VA
23834-2938
US

IV. Provider business mailing address

524 COLONIAL AVE
COLONIAL HEIGHTS VA
23834-3412
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-0533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305216282
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: