Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT026378 | PA |
NPI | 1053839522 |
---|---|
Provider Name | Christina A Hefferon |
First Address | Berwyn, PA 19312-1671 |
Second Address | Berwyn, PA 19312-1671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2017 |
Last Update Date | 05/08/2021 |