Provider Demographics
NPI:1407169964
Name:WHITNEY, NATHAN T (PT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:T
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:11223 W 22ND ST
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5706
Practice Address - Country:US
Practice Address - Phone:708-483-0005
Practice Address - Fax:708-409-1393
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00875197OtherMEDICARE RAILROAD
ILP00931602OtherMEDICARE RAILROAD
ILP00931602OtherMEDICARE RAILROAD
IL214692029Medicare PIN