Provider Demographics
NPI:1386046027
Name:HEAFNER, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HEAFNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 PEARL PKWY APT 307
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2495
Mailing Address - Country:US
Mailing Address - Phone:618-604-3293
Mailing Address - Fax:
Practice Address - Street 1:3120 PEARL PKWY APT 307
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2495
Practice Address - Country:US
Practice Address - Phone:618-604-3293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00129632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic