Provider Demographics
NPI:1457646804
Name:GRIFFIN, WHITNEY K (PTA)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:K
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 CYPRESS KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-8775
Mailing Address - Country:US
Mailing Address - Phone:870-930-4246
Mailing Address - Fax:
Practice Address - Street 1:528 HIGHWAY 49 N
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4087
Practice Address - Country:US
Practice Address - Phone:870-560-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2513225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant