Provider Demographics
NPI:1043479942
Name:WHITAKER, TERESA ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 TAYLOR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:KY
Mailing Address - Zip Code:41006
Mailing Address - Country:US
Mailing Address - Phone:859-472-2217
Mailing Address - Fax:
Practice Address - Street 1:305 TAYLOR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:KY
Practice Address - Zip Code:41006
Practice Address - Country:US
Practice Address - Phone:859-472-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA00846225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant