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NPI Code Detail

MEDICARE: REBECCA HEFFERNAN PT

MEDICARE:   REBECCA  HEFFERNAN  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
1225100000XPhysical Therapist070007033IL

General Provider Information

NPI Number : 1912113903
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA HEFFERNAN PT
Provider Business Mailing Address
First Line : 600 OAKMONT LN STE 600C
Second Line :
City : WESTMONT
State : IL
Zip : 60559-5548
Country : US
Telephone Number : 630-575-6250
Fax Number : 630-575-7450
Provider Business Practice Location Address
First Line : 114 N VINE ST
Second Line :
City : URBANA
State : IL
Zip : 61802-2700
Country : US
Telephone Number : 217-352-3330
Fax Number : 217-344-4465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 01/16/2018

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Directions to “ REBECCA HEFFERNAN PT” Practice Location

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