Provider Demographics
NPI:1699223289
Name:RICHARDVILLE, HEATHER MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:RICHARDVILLE
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 1:10006 AUBURN PARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2389
Mailing Address - Country:US
Mailing Address - Phone:260-497-7191
Mailing Address - Fax:260-497-7791
Practice Address - Street 1:10006 AUBURN PARK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2389
Practice Address - Country:US
Practice Address - Phone:260-497-7191
Practice Address - Fax:260-497-7791
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011633A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist