Provider Demographics
NPI:1407197536
Name:KEVITT, HEATHER A M (HEATHER KEVITT, NCTM)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A M
Last Name:KEVITT
Suffix:
Gender:F
Credentials:HEATHER KEVITT, NCTM
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:AM
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5740 ECHO RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-2935
Mailing Address - Country:US
Mailing Address - Phone:612-703-4390
Mailing Address - Fax:
Practice Address - Street 1:23505 SMITHTOWN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-4541
Practice Address - Country:US
Practice Address - Phone:952-470-8555
Practice Address - Fax:952-401-8785
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist