Provider Demographics
NPI:1770657264
Name:WHITTLE, WAYNE BRUCE (PT)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:BRUCE
Last Name:WHITTLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 66TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8408
Mailing Address - Country:US
Mailing Address - Phone:727-345-3346
Mailing Address - Fax:727-345-3595
Practice Address - Street 1:40 66TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8408
Practice Address - Country:US
Practice Address - Phone:727-345-3346
Practice Address - Fax:727-345-3595
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7576ZMedicare UPIN