Provider Demographics
NPI:1568505972
Name:WHITFIELD, DAMON CRAIG (PT, ATC)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:CRAIG
Last Name:WHITFIELD
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3277 NEEDLES DR
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-8796
Mailing Address - Country:US
Mailing Address - Phone:231-526-2186
Mailing Address - Fax:
Practice Address - Street 1:3277 NEEDLES DR
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-8796
Practice Address - Country:US
Practice Address - Phone:231-526-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1200020302255A2300X
MI5501011595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer