Provider Demographics
NPI:1619481546
Name:WHITTUM, CARA A (CDE)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:A
Last Name:WHITTUM
Suffix:
Gender:F
Credentials:CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GILES RD
Mailing Address - Street 2:
Mailing Address - City:EAST KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03827-2010
Mailing Address - Country:US
Mailing Address - Phone:603-770-1169
Mailing Address - Fax:
Practice Address - Street 1:21 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4831
Practice Address - Country:US
Practice Address - Phone:603-418-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1986224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist