Provider Demographics
NPI:1427875046
Name:HEATH, RICHARD EDWARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
Last Name:HEATH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3237
Mailing Address - Country:US
Mailing Address - Phone:727-541-2520
Mailing Address - Fax:
Practice Address - Street 1:GULF COAST REHABILITATION AND WELLNESS CENTER. INC
Practice Address - Street 2:6250 PARK BLVD
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781
Practice Address - Country:US
Practice Address - Phone:727-541-2520
Practice Address - Fax:727-544-8971
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20830225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant