Provider Demographics
NPI:1013552314
Name:ROSE, WHITNYE ROBIN
Entity Type:Individual
Prefix:
First Name:WHITNYE
Middle Name:ROBIN
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 FERNLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-5941
Mailing Address - Country:US
Mailing Address - Phone:256-714-6389
Mailing Address - Fax:
Practice Address - Street 1:103 FERNLEAF WAY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-5941
Practice Address - Country:US
Practice Address - Phone:256-714-6389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-10
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer