Basic Information
| Provider Information | |||||||||
| NPI: | 1558413203 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HETCKO | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 408 CRIMSON DR | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152371076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243821507 | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 FREEPORT RD | ||||||||
| Address2: | 200 BUILDING, SUITE 4000 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152153301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127845010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT013938L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.