Individual
JOHN KWAK-HEFFERAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5535 S WILLIAMSON BLVD, SUITE 774, PORT ORANGE, FL 32128-8311
(800) 330-7711
Mailing address
5535 S WILLIAMSON BLVD, SUITE 774, PORT ORANGE, FL 32128-8311
(800) 330-7711
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160007217
IL
Other
Enumeration date
04/19/2016
Last updated
04/19/2016
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