Provider Demographics
NPI:1477695948
Name:COUVILLION, HEATHER VINICKI (PT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:VINICKI
Last Name:COUVILLION
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:KALON
Other - Last Name:VINICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:350 N HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2177
Mailing Address - Country:US
Mailing Address - Phone:901-226-4003
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:2100 EXETER RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3966
Practice Address - Country:US
Practice Address - Phone:901-757-1350
Practice Address - Fax:901-757-3496
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist