Provider Demographics
NPI:1386671097
Name:WHITLOCK, KENNETH S (ATC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:S
Last Name:WHITLOCK
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 1:211 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15417-9570
Mailing Address - Country:US
Mailing Address - Phone:724-785-6699
Mailing Address - Fax:724-785-6699
Practice Address - Street 1:211 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-9570
Practice Address - Country:US
Practice Address - Phone:724-785-6699
Practice Address - Fax:724-785-6699
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002304A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer