Provider Demographics
NPI:1053318816
Name:HETZEL, STEPHEN FRANCIS (PT, OCS, ATC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:FRANCIS
Last Name:HETZEL
Suffix:
Gender:M
Credentials:PT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HARRY AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19607-9764
Mailing Address - Country:US
Mailing Address - Phone:610-775-3064
Mailing Address - Fax:
Practice Address - Street 1:1940 N 13TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-1539
Practice Address - Country:US
Practice Address - Phone:610-921-0609
Practice Address - Fax:610-921-2652
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003652L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHE 474577Medicare ID - Type Unspecified