Provider Demographics
NPI:1083602536
Name:CRISWELL, WHITNEY E (PTA)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:E
Last Name:CRISWELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:WHITNEY
Other - Middle Name:E
Other - Last Name:TERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:801 E WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-5111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 E WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-5111
Practice Address - Country:US
Practice Address - Phone:641-684-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01058225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant