Provider Demographics
NPI:1952511800
Name:WHITEHURST, JOSEPH CARL (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CARL
Last Name:WHITEHURST
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 1:411 E ORANGE ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5054
Mailing Address - Country:US
Mailing Address - Phone:863-617-9400
Mailing Address - Fax:863-688-9858
Practice Address - Street 1:411 E ORANGE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5054
Practice Address - Country:US
Practice Address - Phone:863-617-9400
Practice Address - Fax:863-688-9858
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist