Provider Demographics
NPI:1639488729
Name:WHITMIRE, SHEENA ASHLEY (PTA)
Entity Type:Individual
Prefix:MISS
First Name:SHEENA
Middle Name:ASHLEY
Last Name:WHITMIRE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 IVY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-5048
Mailing Address - Country:US
Mailing Address - Phone:770-866-2911
Mailing Address - Fax:
Practice Address - Street 1:3615 BRASELTON HWY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-5906
Practice Address - Country:US
Practice Address - Phone:770-904-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002704225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant