Provider Demographics
NPI:1548773088
Name:WHITING, AMANDA R (DPT PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:WHITING
Suffix:
Gender:F
Credentials:DPT PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1678
Mailing Address - Country:US
Mailing Address - Phone:715-682-8000
Mailing Address - Fax:715-682-3145
Practice Address - Street 1:400 3RD AVE W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1678
Practice Address - Country:US
Practice Address - Phone:715-682-8000
Practice Address - Fax:715-682-3145
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13844-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13844-24Medicaid