Provider Demographics
NPI:1497815161
Name:HEUBERGER, DAVID PRESTON (MPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PRESTON
Last Name:HEUBERGER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 8TH AVE W STE A
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-3119
Mailing Address - Country:US
Mailing Address - Phone:941-722-4000
Mailing Address - Fax:941-722-4700
Practice Address - Street 1:1401 8TH AVE W STE A
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-3119
Practice Address - Country:US
Practice Address - Phone:941-722-4000
Practice Address - Fax:941-722-4700
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT22931OtherSTATE OF FLORIDA
FL016466400Medicaid