MEDICARE: GRANT WILLIAM HESSBERGER PT, 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	PTL.0014149	CO
2	225100000X	Physical Therapist	2305210216	VA

General Provider Information

NPI Number	:	1588011555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT WILLIAM HESSBERGER PT, DPT

Provider Business Mailing Address
First Line	:	1377 MOTOR PKWY STE 307
Second Line	:
City	:	ISLANDIA
State	:	NY
Zip	:	11749-5258
Country	:	US
Telephone Number	:	631-580-5200
Fax Number	:	631-760-8306

Provider Business Practice Location Address
First Line	:	801 POINDEXTER ST STE 219
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-2358
Country	:	US
Telephone Number	:	757-548-0014
Fax Number	:

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

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	08/30/2020

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