Provider Demographics
NPI:1972102689
Name:WHITEHURST, STEPHEN TOD (LMT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:TOD
Last Name:WHITEHURST
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-0116
Mailing Address - Country:US
Mailing Address - Phone:540-392-3723
Mailing Address - Fax:
Practice Address - Street 1:2001 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6678
Practice Address - Country:US
Practice Address - Phone:540-392-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019003670225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist