Healthcare Provider Details

I. General information

NPI: 1124807995
Provider Name (Legal Business Name): HOBIE HEGGSTROM CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 WELLSIAN WAY
RICHLAND WA
99352-4116
US

IV. Provider business mailing address

317 WELLSIAN WAY
RICHLAND WA
99352-4116
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-8561
  • Fax:
Mailing address:
  • Phone: 509-943-8561
  • Fax: 509-572-9192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPS61406882
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: