Provider Demographics
NPI:1467062505
Name:WHITTLE, TAYLOR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WHITTLE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6604
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-8053
Mailing Address - Country:US
Mailing Address - Phone:951-340-0431
Mailing Address - Fax:951-893-5135
Practice Address - Street 1:4211B VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3502
Practice Address - Country:US
Practice Address - Phone:951-340-0431
Practice Address - Fax:951-893-5135
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT298068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist