Provider Demographics
NPI:1114162310
Name:WHITTAKER, WHITNEY AYNE (DPT, PT)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:AYNE
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 UVILLA ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH JUNCTION
Mailing Address - State:WV
Mailing Address - Zip Code:25442-4619
Mailing Address - Country:US
Mailing Address - Phone:304-268-1518
Mailing Address - Fax:
Practice Address - Street 1:1000 HERITAGE CIRCLE
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-0010
Practice Address - Country:US
Practice Address - Phone:866-915-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT002732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist