Provider Demographics
NPI:1255717328
Name:HEDDERSON, WILL (LAT, ATC)
Entity type:Individual
Prefix:
First Name:WILL
Middle Name:
Last Name:HEDDERSON
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 SW 20TH AVE APT 1103
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4413
Mailing Address - Country:US
Mailing Address - Phone:352-727-0246
Mailing Address - Fax:
Practice Address - Street 1:3940 SW 20TH AVE APT 1103
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-4413
Practice Address - Country:US
Practice Address - Phone:352-727-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL29772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer