Provider Demographics
NPI:1598279929
Name:HEFNER, WAYNE (DPT)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:HEFNER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-9744
Mailing Address - Country:US
Mailing Address - Phone:724-471-2942
Mailing Address - Fax:
Practice Address - Street 1:2 W 10TH ST
Practice Address - Street 2:
Practice Address - City:MARCUS HOOK
Practice Address - State:PA
Practice Address - Zip Code:19061-4513
Practice Address - Country:US
Practice Address - Phone:724-801-8095
Practice Address - Fax:724-801-8095
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist