Provider Demographics
NPI:1295061430
Name:HEFFERON, ERIC (PT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:HEFFERON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19420N 59TH AVE E500
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6881
Mailing Address - Country:US
Mailing Address - Phone:602-639-1066
Mailing Address - Fax:866-281-9664
Practice Address - Street 1:19420N 59TH AVE E500
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6881
Practice Address - Country:US
Practice Address - Phone:623-208-7575
Practice Address - Fax:866-281-9664
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8663PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist