Provider Demographics
NPI:1356686596
Name:LOURDON, WHITNEY (PTA)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:LOURDON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1074
Mailing Address - Street 2:631 MATILDA AVENUE
Mailing Address - City:LEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:16851-1074
Mailing Address - Country:US
Mailing Address - Phone:717-552-8287
Mailing Address - Fax:
Practice Address - Street 1:434 W AARON DR
Practice Address - Street 2:SUITE 103
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-3074
Practice Address - Country:US
Practice Address - Phone:814-235-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE009574225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant