MEDICARE: LAURA HECKROTH

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
2	225100000X	Physical Therapist	12882220-2401	UT

General Provider Information

NPI Number	:	1669885562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA HECKROTH

Provider Business Mailing Address
First Line	:	2482 DOUGLAS ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106
Country	:	US
Telephone Number	:	812-350-2287
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 W BELLWOOD LN
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-5435
Country	:	US
Telephone Number	:	812-350-2287
Fax Number	:

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

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	09/18/2023

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Directions to “ LAURA HECKROTH ” Practice Location

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