Provider Demographics
NPI:1417135229
Name:ELLSWORTH, WHITNEY MERDITH (DRPT)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:MERDITH
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:DRPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4158 S HARVARD AVE
Mailing Address - Street 2:STE E1
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2626
Mailing Address - Country:US
Mailing Address - Phone:916-563-7954
Mailing Address - Fax:
Practice Address - Street 1:7850 FREEMAN AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2133
Practice Address - Country:US
Practice Address - Phone:913-334-3666
Practice Address - Fax:913-299-1495
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1103740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist