MEDICARE: MRS. HEATHER VINICKI COUVILLION P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5669	TN

General Provider Information

NPI Number	:	1477695948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER VINICKI COUVILLION P.T.

Provider Business Mailing Address
First Line	:	350 N HUMPHREYS BLVD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2177
Country	:	US
Telephone Number	:	901-226-4003
Fax Number	:	901-227-8591

Provider Business Practice Location Address
First Line	:	2100 EXETER RD
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-3966
Country	:	US
Telephone Number	:	901-757-1350
Fax Number	:	901-757-3496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	05/02/2025

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