MEDICARE: MR. STEPHEN FRANCIS HETZEL PT, OCS, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PT003652L	PA

General Provider Information

NPI Number	:	1053318816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN FRANCIS HETZEL PT, OCS, ATC

Provider Business Mailing Address
First Line	:	12 HARRY AVE
Second Line	:
City	:	READING
State	:	PA
Zip	:	19607-9764
Country	:	US
Telephone Number	:	610-775-3064
Fax Number	:

Provider Business Practice Location Address
First Line	:	1940 N 13TH ST
Second Line	:	SUITE 130
City	:	READING
State	:	PA
Zip	:	19604-1539
Country	:	US
Telephone Number	:	610-921-0609
Fax Number	:	610-921-2652

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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