Provider Demographics
NPI:1417523168
Name:HEEBNER, ERICA NICHOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:NICHOLE
Last Name:HEEBNER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD STE 205
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6797
Mailing Address - Country:US
Mailing Address - Phone:301-665-4950
Mailing Address - Fax:301-665-4956
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 101
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6711
Practice Address - Country:US
Practice Address - Phone:301-665-4970
Practice Address - Fax:301-665-4956
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA024833225100000X
MD28398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist