Provider Demographics
NPI:1467104687
Name:WHITTEN, NATHANIEL PARKER (DPT)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:PARKER
Last Name:WHITTEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 THORNTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2891
Mailing Address - Country:US
Mailing Address - Phone:207-294-8448
Mailing Address - Fax:
Practice Address - Street 1:7581 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-5939
Practice Address - Country:US
Practice Address - Phone:850-453-9475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL397682251S0007X
MEPT60262251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports