Provider Demographics
NPI:1346438306
Name:ZUMDAHL, WHITTNEY J (MPT)
Entity Type:Individual
Prefix:MS
First Name:WHITTNEY
Middle Name:J
Last Name:ZUMDAHL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:WHITTNEY
Other - Middle Name:J
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-0268
Mailing Address - Country:US
Mailing Address - Phone:815-599-7950
Mailing Address - Fax:815-599-7974
Practice Address - Street 1:1010 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6600
Practice Address - Country:US
Practice Address - Phone:815-599-6340
Practice Address - Fax:815-599-6748
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015182225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist