Provider Demographics
NPI:1609020205
Name:WHITAKER, TITUS S (LMT)
Entity Type:Individual
Prefix:MR
First Name:TITUS
Middle Name:S
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 TURKEY LAKE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4200
Mailing Address - Country:US
Mailing Address - Phone:407-538-7669
Mailing Address - Fax:
Practice Address - Street 1:6000 TURKEY LAKE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4200
Practice Address - Country:US
Practice Address - Phone:407-538-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43271225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA43271OtherMASSAGE THERAPIST LICENSE