Provider Demographics
NPI:1992029060
Name:WHITLOCK, JO ANNE (PT)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANNE
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JO
Other - Middle Name:ANNE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3201 SANDY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-1934
Mailing Address - Country:US
Mailing Address - Phone:727-308-8231
Mailing Address - Fax:
Practice Address - Street 1:3201 SANDY RIDGE DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-1934
Practice Address - Country:US
Practice Address - Phone:727-308-8231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19930225100000X
IN05010160A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015172300Medicaid