Provider Demographics
NPI:1710653118
Name:WHITENACK, ANNESKA NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANNESKA
Middle Name:NICOLE
Last Name:WHITENACK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 NW 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5793
Mailing Address - Country:US
Mailing Address - Phone:502-472-7477
Mailing Address - Fax:
Practice Address - Street 1:747 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4055
Practice Address - Country:US
Practice Address - Phone:954-316-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist