MEDICARE: HEIDI ANN HIRSBRUNNER 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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1386607687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI ANN HIRSBRUNNER ATC

Provider Business Mailing Address
First Line	:	1600 E 3RD AVE
Second Line	:	#2013
City	:	SAN MATEO
State	:	CA
Zip	:	94401-2166
Country	:	US
Telephone Number	:	702-493-1097
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 DIVISADERO ST
Second Line	:	SUITE 240
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3011
Country	:	US
Telephone Number	:	415-353-7782
Fax Number	:	415-353-7593

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

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	07/08/2007

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Directions to “ HEIDI ANN HIRSBRUNNER ATC” Practice Location

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