Provider Demographics
NPI:1578017570
Name:WHALEN, AMELIA (DPT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:WHALEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2042 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0247
Mailing Address - Country:US
Mailing Address - Phone:207-316-3417
Mailing Address - Fax:207-605-0260
Practice Address - Street 1:2042 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-0247
Practice Address - Country:US
Practice Address - Phone:207-316-3417
Practice Address - Fax:207-605-0260
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPT4702OtherSTATE LICENSE