Provider Demographics
NPI:1396756698
Name:HETHERINGTON, MARGARET LYNN (PT)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:LYNN
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 MISSION ST STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3652
Mailing Address - Country:US
Mailing Address - Phone:831-471-2093
Mailing Address - Fax:831-471-2093
Practice Address - Street 1:517 MISSION ST STE D
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3652
Practice Address - Country:US
Practice Address - Phone:831-471-2093
Practice Address - Fax:831-471-2093
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 15051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT 150510Medicare ID - Type Unspecified