Provider Demographics
NPI:1669645370
Name:DENNIS MC WHORTER
Entity Type:Organization
Organization Name:DENNIS MC WHORTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:MCWHORTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:937-371-5389
Mailing Address - Street 1:2215 ROSEANNE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-6317
Mailing Address - Country:US
Mailing Address - Phone:937-878-5004
Mailing Address - Fax:937-235-1442
Practice Address - Street 1:2215 ROSEANNE CT
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-6317
Practice Address - Country:US
Practice Address - Phone:937-878-5004
Practice Address - Fax:937-235-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06007314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06007Medicaid
OH06007Medicare PIN
OH06007Medicaid