Provider Demographics
NPI:1568565422
Name:HEFFERNAN, REBECCA (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HPT INC. 2335 STATE AVE.
Mailing Address - Street 2:SUITE E
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405
Mailing Address - Country:US
Mailing Address - Phone:850-763-1992
Mailing Address - Fax:850-763-4808
Practice Address - Street 1:HPT INC. 2335 STATE AVE.
Practice Address - Street 2:SUITE E
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-763-1992
Practice Address - Fax:850-763-4808
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0007288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist