Provider Demographics
NPI:1518028588
Name:CARRAWAY, HEATHER FLOYD (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:FLOYD
Last Name:CARRAWAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7696 ENDERBY AVE E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4924
Mailing Address - Country:US
Mailing Address - Phone:904-412-7478
Mailing Address - Fax:
Practice Address - Street 1:2245 PLANTATION CENTER DR
Practice Address - Street 2:SUITE 57
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-3352
Practice Address - Country:US
Practice Address - Phone:904-374-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23307174400000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA326059Medicaid
GA742840135AMedicaid
GA10046956Medicaid
FL892083400Medicaid