Provider Demographics
NPI:1376589184
Name:WHETSTONE, JERRY ALLEN (ATC)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:ALLEN
Last Name:WHETSTONE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12315 STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-9572
Mailing Address - Country:US
Mailing Address - Phone:937-846-1145
Mailing Address - Fax:937-395-3930
Practice Address - Street 1:3490 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2500
Practice Address - Country:US
Practice Address - Phone:937-395-3929
Practice Address - Fax:937-395-3930
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0003592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer