Provider Demographics
NPI:1760153621
Name:WHITLOW, KERI
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:WHITLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 DOGWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-3727
Mailing Address - Country:US
Mailing Address - Phone:804-694-6088
Mailing Address - Fax:
Practice Address - Street 1:5638 DOGWOOD FOREST DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-3727
Practice Address - Country:US
Practice Address - Phone:804-694-6088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
VA2306605147225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant