Provider Demographics
NPI:1225310303
Name:WHELAN, E. ANNE
Entity Type:Individual
Prefix:MS
First Name:E. ANNE
Middle Name:
Last Name:WHELAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:WHELAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:6820 THOMPSON RD
Mailing Address - Street 2:PO BOX 4754
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13211-1321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6820 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13211-1321
Practice Address - Country:US
Practice Address - Phone:315-434-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist