Provider Demographics
NPI:1033212386
Name:WHITMIRE, VAN CARROL (MHS, ATC, LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:CARROL
Last Name:WHITMIRE
Suffix:
Gender:M
Credentials:MHS, ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 JETER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PENROSE
Mailing Address - State:NC
Mailing Address - Zip Code:28766-8771
Mailing Address - Country:US
Mailing Address - Phone:828-862-8221
Mailing Address - Fax:828-884-8269
Practice Address - Street 1:1 BREVARD COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-0000
Practice Address - Country:US
Practice Address - Phone:828-884-8346
Practice Address - Fax:828-884-8269
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer