Provider Demographics
NPI:1760973184
Name:WHALEN, DEBORAH WARD (MPT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:WARD
Last Name:WHALEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WOODGROVE LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9709
Mailing Address - Country:US
Mailing Address - Phone:919-744-5173
Mailing Address - Fax:
Practice Address - Street 1:109 WOODGROVE LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9709
Practice Address - Country:US
Practice Address - Phone:919-744-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP6835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty