Provider Demographics
NPI:1841623972
Name:HEGGERNES, STEVEN (PT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:HEGGERNES
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 1:1127 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1467
Mailing Address - Country:US
Mailing Address - Phone:715-243-3940
Mailing Address - Fax:715-243-3941
Practice Address - Street 1:575 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1467
Practice Address - Country:US
Practice Address - Phone:715-243-3940
Practice Address - Fax:715-243-3941
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12383-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist