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General NPI Number Information
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NPI Number | 1720953359
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Entity Type | Organization
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Legal Business Name | PURPLE HERON THERAPY PARTNERS LLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 55914 BAY RD
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City | ASTOR
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State | FL
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Zip | 32102-2612
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Country | US
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Telephone | 321-578-9673
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 975
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City | DE LEON SPRINGS
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State | FL
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Zip | 32130-0975
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Country | US
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Telephone | 321-578-9673
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHARLOTTE DARNELL
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Credential | MSC.,CCC-SLP
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Telephone | 321-578-9673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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