Provider Demographics
NPI:1710297528
Name:WHITSEL, SAMUEL DEAN (DPT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:DEAN
Last Name:WHITSEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 DUNN RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6762
Mailing Address - Country:US
Mailing Address - Phone:314-839-0002
Mailing Address - Fax:314-839-5994
Practice Address - Street 1:3501 DUNN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6762
Practice Address - Country:US
Practice Address - Phone:314-839-0002
Practice Address - Fax:314-839-5994
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010029439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist