Active NPI
Laura Heberley, RN, M.S., ATC
- Athletic Trainer
- Woodlyn, PA
National Provider Identifier
1083034631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT003644
- Practice address
- 1405 Grant Ave
Woodlyn, PA 19094-1615 - Phone
- (570) 242-4585
- NPI assigned
- Apr 22, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | RT003644 | PA | Primary |
Addresses
Primary practice location
1405 Grant Ave
Woodlyn, PA 19094-1615
Mailing address
1405 Grant Ave
Woodlyn, PA 19094-1615
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2255A2300X | Other | PROVIDER CODE 22 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RT003644 | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398124800000",
"number": "1083034631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1405 GRANT AVE",
"city": "WOODLYN",
"state": "PA",
"postal_code": "190941615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1405 GRANT AVE",
"city": "WOODLYN",
"state": "PA",
"postal_code": "190941615",
"telephone_number": "570-242-4585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEBERLEY",
"first_name": "LAURA",
"name_prefix": "Ms.",
"credential": "RN, M.S., ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-04-22",
"last_updated": "2014-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT003644",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROVIDER CODE 22",
"identifier": "2255A2300X",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodlyn, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.