Provider Demographics
NPI:1831496298
Name:WHITWORTH, JOHN WARFIELD (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WARFIELD
Last Name:WHITWORTH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11850 NICHOLAS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4476
Mailing Address - Country:US
Mailing Address - Phone:877-230-3885
Mailing Address - Fax:402-505-9753
Practice Address - Street 1:1050 E MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3930
Practice Address - Country:US
Practice Address - Phone:509-925-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160132513225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant