MEDICARE: CHRISTOPHER HEFFERNAN

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598316515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER HEFFERNAN

Provider Business Mailing Address
First Line	:	925 OASIS PALM CIR APT 2408
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-3345
Country	:	US
Telephone Number	:	203-536-4651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 OAKLEY SEAVER DR STE 11
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-1974
Country	:	US
Telephone Number	:	352-241-0347
Fax Number	:

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

Provider Enumeration Date	:	09/20/2019
Last Update Date	:	09/20/2019

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