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NPI Code Detail

MEDICARE: MARY KATHERINE HEGARTY PT

MEDICARE: MARY KATHERINE HEGARTY PT
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
1225100000XPhysical Therapist1477AZ

General Provider Information

NPI Number : 1215425202
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY KATHERINE HEGARTY PT
Provider Business Mailing Address
First Line : 4830 HIGHWAY 260 STE 105
Second Line :
City : LAKESIDE
State : AZ
Zip : 85929-5851
Country : US
Telephone Number : 928-532-1221
Fax Number :
Provider Business Practice Location Address
First Line : 4830 HIGHWAY 260 STE 105
Second Line :
City : LAKESIDE
State : AZ
Zip : 85929-5851
Country : US
Telephone Number : 928-532-1221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2018
Last Update Date : 04/25/2018

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Directions to “ MARY KATHERINE HEGARTY PT” Practice Location

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