Healthcare Provider Details

I. General information

NPI: 1336871037
Provider Name (Legal Business Name): MONICA LYNN HEARD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 3RD ST
ROCKLEDGE FL
32955-5703
US

IV. Provider business mailing address

970 LISA DR
TITUSVILLE FL
32780-7110
US

V. Phone/Fax

Practice location:
  • Phone: 321-622-8792
  • Fax:
Mailing address:
  • Phone: 407-637-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTT38903
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: