MEDICARE: MRS. ESTHER K HEFETS DPT

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	225100000X	Physical Therapist	PT22227	CA
2	225100000X	Physical Therapist	1229357	TX

General Provider Information

NPI Number	:	1558795302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ESTHER K HEFETS DPT

Provider Business Mailing Address
First Line	:	11838 PASO ROBLES AVE
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-2561
Country	:	US
Telephone Number	:	818-832-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	11838 PASO ROBLES AVE
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-2561
Country	:	US
Telephone Number	:	818-832-8222
Fax Number	:

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

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	08/29/2013

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