Provider Demographics
NPI:1558996702
Name:WHETSTONE, PHILLIP DAVID
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:DAVID
Last Name:WHETSTONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3753 N 108TH ST
Mailing Address - Street 2:
Mailing Address - City:NARDIN
Mailing Address - State:OK
Mailing Address - Zip Code:74646-5072
Mailing Address - Country:US
Mailing Address - Phone:580-363-8560
Mailing Address - Fax:
Practice Address - Street 1:1601 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-4409
Practice Address - Country:US
Practice Address - Phone:580-762-0927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT-2343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist