Healthcare Provider Details

I. General information

NPI: 1497815161
Provider Name (Legal Business Name): DAVID PRESTON HEUBERGER MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 8TH AVE W STE A
PALMETTO FL
34221-3119
US

IV. Provider business mailing address

1401 8TH AVE W STE A
PALMETTO FL
34221-3119
US

V. Phone/Fax

Practice location:
  • Phone: 941-722-4000
  • Fax: 941-722-4700
Mailing address:
  • Phone: 941-722-4000
  • Fax: 941-722-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 22931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: