MEDICARE: DEBRA HEJDE PT

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	8978	CO

General Provider Information

NPI Number	:	1679961171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA HEJDE PT

Provider Business Mailing Address
First Line	:	802 W DRAKE RD STE 133A
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-5567
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 W DRAKE RD STE 133A
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-5567
Country	:	US
Telephone Number	:	970-494-6449
Fax Number	:

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

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	01/06/2015

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