Provider Demographics
NPI:1376164665
Name:WHIGHAM, DAVID LEONARD (LP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEONARD
Last Name:WHIGHAM
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6312 ALABASTER DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5729
Mailing Address - Country:US
Mailing Address - Phone:254-702-6864
Mailing Address - Fax:
Practice Address - Street 1:4008 E STAN SCHLUETER LOOP STE 108
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-8537
Practice Address - Country:US
Practice Address - Phone:254-702-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT124457225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist