Provider Demographics
NPI:1497113096
Name:WHITWORTH, TERRI-JOHN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TERRI-JOHN
Middle Name:
Last Name:WHITWORTH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TERRI-JOHN
Other - Middle Name:
Other - Last Name:ODOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:184 E REDSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5372
Mailing Address - Country:US
Mailing Address - Phone:850-689-3127
Mailing Address - Fax:
Practice Address - Street 1:184 E REDSTONE AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5372
Practice Address - Country:US
Practice Address - Phone:850-689-3127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 31188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist