MEDICARE: HEATHER NICOLE DERENICK 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	PT027106	PA

General Provider Information

NPI Number	:	1700367000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER NICOLE DERENICK DPT

Provider Business Mailing Address
First Line	:	4750 LINDLE RD STE 100
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17111-2428
Country	:	US
Telephone Number	:	717-803-3342
Fax Number	:	717-974-8743

Provider Business Practice Location Address
First Line	:	488 N MAIN ST
Second Line	:
City	:	SPRING GROVE
State	:	PA
Zip	:	17362-1122
Country	:	US
Telephone Number	:	717-690-0107
Fax Number	:	717-974-8743

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

Provider Enumeration Date	:	08/24/2018
Last Update Date	:	08/27/2024

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Directions to “ HEATHER NICOLE DERENICK DPT” Practice Location

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