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General NPI Number Information
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NPI Number | 1700367000
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Entity Type | Individual
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Provider Name | HEATHER NICOLE DERENICK DPT
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Gender | Female
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 488 N MAIN ST
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City | SPRING GROVE
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State | PA
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Zip | 17362-1122
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Country | US
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Telephone | 717-690-0107
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Fax | 717-974-8743
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Provider Business Mailing Address
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Address Line | 4750 LINDLE RD STE 100
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City | HARRISBURG
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State | PA
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Zip | 17111-2428
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Country | US
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Telephone | 717-803-3342
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Fax | 717-974-8743
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT027106
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License Number State | PA
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