Provider Demographics
NPI:1568784908
Name:HEFFERNAN, CASEY A (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:A
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3018
Mailing Address - Country:US
Mailing Address - Phone:781-245-0055
Mailing Address - Fax:781-245-8855
Practice Address - Street 1:414 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3018
Practice Address - Country:US
Practice Address - Phone:781-245-0055
Practice Address - Fax:781-245-8855
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist