Provider Demographics
NPI:1659466597
Name:CARVILL-HENRY, HEATHER (MSPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CARVILL-HENRY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEE
Other - Last Name:CARVILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 PENBROOKE DRIVE
Mailing Address - Street 2:BLDG 2 SUITE A
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625
Mailing Address - Country:US
Mailing Address - Phone:585-377-9626
Mailing Address - Fax:585-227-3077
Practice Address - Street 1:401 PENBROOKE DRIVE
Practice Address - Street 2:BLDG 2 SUITE A
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625
Practice Address - Country:US
Practice Address - Phone:585-377-9626
Practice Address - Fax:585-227-3077
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11225459OtherCAQH NUMBER
NY11225459OtherCAQH NUMBER