Healthcare Provider Details

I. General information

NPI: 1710790571
Provider Name (Legal Business Name): JACLYN HERON-SEPULVEDA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN MICHELLE HERON

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 WILLAMETTE ST STE 5
EUGENE OR
97405-7211
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 541-844-1728
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number65696
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20362
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: