Basic Information
| Provider Information | |||||||||
| NPI: | 1598316515 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEFFERNAN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 OASIS PALM CIR APT 2408 | ||||||||
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| City: | OCOEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347613345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035364651 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 OAKLEY SEAVER DR STE 11 | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347111974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522410347 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2019 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.