Individual
HEATHER SURRETT-VESTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1562
(336) 765-5664
Mailing address
187 GRADE ST, RURAL HALL, NC 27045-9772
(704) 527-9550
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3120
LICENSE#
NC
Enumeration date
11/07/2006
Last updated
07/08/2007
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