Provider Demographics
NPI:1063504827
Name:PREVILL, HEATHER L (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:PREVILL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:PREVILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:15127 S JOG RD STE 210
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1251
Mailing Address - Country:US
Mailing Address - Phone:561-498-1098
Mailing Address - Fax:
Practice Address - Street 1:15127 S JOG RD STE 210
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1251
Practice Address - Country:US
Practice Address - Phone:561-498-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38543225100000X
FLPT24843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty