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119 S Burrowes St Ste 702, State College, PA 16801-3864 | |
(814) 263-5460 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Clinic/center |
Location | 119 S Burrowes St Ste 702, State College, Pennsylvania |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1174145049 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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133V00000X | Dietitian, Registered | (* (Not Available)) | Secondary |
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Theresa Hedrick |
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Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1811404759 PECOS PAC ID: 7618308784 Enrollment ID: I20200603001166 |
Mailing Address | Practice Location Address |
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2388 Charleston Dr, State College, PA 16801-2472 Ph: (814) 263-5460 | 119 S Burrowes St Ste 702, State College, PA 16801-3864 Ph: (814) 263-5460 |