Provider Demographics
NPI:1497821573
Name:STRAHL, HEATHER RAWSON (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAWSON
Last Name:STRAHL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WILD MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 ENTERPRISE BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6301
Practice Address - Country:US
Practice Address - Phone:864-365-0200
Practice Address - Fax:864-365-0205
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1236363AM0700X
SC1630363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ55443Medicare UPIN
SCAA6631Medicare PIN