Provider Demographics
NPI:1720635659
Name:HECKSTALL, QUADEISHA DEMETRIA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:QUADEISHA
Middle Name:DEMETRIA
Last Name:HECKSTALL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4903 FALCON CREEK WAY APT 203
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-0639
Mailing Address - Country:US
Mailing Address - Phone:757-218-1640
Mailing Address - Fax:
Practice Address - Street 1:11745 JEFFERSON AVE STE 4
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4410
Practice Address - Country:US
Practice Address - Phone:757-726-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist