Provider Demographics
NPI:1548583099
Name:WHITMIRE, SANDRA SUE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUE
Last Name:WHITMIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71502 WESTERN SKY TRL
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81403-8702
Mailing Address - Country:US
Mailing Address - Phone:309-221-1183
Mailing Address - Fax:
Practice Address - Street 1:71502 WESTERN SKY TRL
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81403-8702
Practice Address - Country:US
Practice Address - Phone:309-221-1183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160001475225200000X
IL146003873235Z00000X
COSLP.0003661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant