Provider Demographics
NPI:1770958886
Name:HECKEROTH, CHRISTIANE ELISABETH (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTIANE
Middle Name:ELISABETH
Last Name:HECKEROTH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4737 EL CAMINO AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4938
Mailing Address - Country:US
Mailing Address - Phone:916-487-3473
Mailing Address - Fax:916-487-3483
Practice Address - Street 1:4737 EL CAMINO AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4938
Practice Address - Country:US
Practice Address - Phone:916-487-3473
Practice Address - Fax:916-487-3483
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist