Provider Demographics
NPI:1306294285
Name:PATRICKSON, WHITNEY ALLISON (PT)
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:ALLISON
Last Name:PATRICKSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 OSPREY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4955
Mailing Address - Country:US
Mailing Address - Phone:904-491-1701
Mailing Address - Fax:904-491-1702
Practice Address - Street 1:48 OSPREY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4955
Practice Address - Country:US
Practice Address - Phone:904-491-1701
Practice Address - Fax:904-491-1702
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist