Provider Demographics
NPI:1194862623
Name:WHITTEN, MARK L (LMP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:WHITTEN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:640 JADWIN AVE STE J
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4244
Mailing Address - Country:US
Mailing Address - Phone:509-946-4800
Mailing Address - Fax:509-943-1270
Practice Address - Street 1:640 JADWIN AVE STE J
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4244
Practice Address - Country:US
Practice Address - Phone:509-946-4800
Practice Address - Fax:509-943-1270
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014443225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist