Provider Demographics
NPI:1346537115
Name:EASTWOOD, WHITNEY ALYSE (DPT)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ALYSE
Last Name:EASTWOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:ALYSE
Other - Last Name:PRUITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:302592 OLD HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:RATLIFF CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73481-5811
Mailing Address - Country:US
Mailing Address - Phone:580-467-5530
Mailing Address - Fax:
Practice Address - Street 1:2150 W ELK AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1827
Practice Address - Country:US
Practice Address - Phone:580-251-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200347190 AMedicaid
OKOKAAA1477Medicare PIN