Provider Demographics
NPI:1023008877
Name:WHITIS, ANNE K (PT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:K
Last Name:WHITIS
Suffix:
Gender:F
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:P.O. DRAWER PH
Mailing Address - Street 2:CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-8000
Mailing Address - Country:US
Mailing Address - Phone:928-674-7166
Mailing Address - Fax:928-674-7705
Practice Address - Street 1:HIGHWAY 191 AND HOSPITAL ROAD
Practice Address - Street 2:CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7166
Practice Address - Fax:928-674-7705
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT3778Medicaid
AKPT3778Medicaid