Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 3457 | NC |
NPI | 1003184110 |
---|---|
Provider Name | Phillip Hefner |
First Address | Lincolnton, NC 28092-4175 |
Second Address | Huntersville, NC 28078-6190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2011 |
Last Update Date | 02/12/2011 |