Healthcare Provider Details

I. General information

NPI: 1720953359
Provider Name (Legal Business Name): PURPLE HERON THERAPY PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55914 BAY RD
ASTOR FL
32102-2612
US

IV. Provider business mailing address

PO BOX 975
DE LEON SPRINGS FL
32130-0975
US

V. Phone/Fax

Practice location:
  • Phone: 321-578-9673
  • Fax:
Mailing address:
  • Phone: 321-578-9673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE DARNELL
Title or Position: CEO
Credential: MSC.,CCC-SLP
Phone: 321-578-9673