Provider Demographics
NPI:1306561600
Name:TAWFIK, HEAVAN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:HEAVAN
Middle Name:
Last Name:TAWFIK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12912 LEEDS CT APT G45
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4781
Mailing Address - Country:US
Mailing Address - Phone:386-290-9055
Mailing Address - Fax:
Practice Address - Street 1:7179 40TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4560
Practice Address - Country:US
Practice Address - Phone:386-290-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL010596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist