Provider Demographics
NPI:1023430386
Name:SMITH, WHITNEY BROOKS (PT)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:BROOKS
Last Name:SMITH
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 1:106 COLUMNS PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-8068
Mailing Address - Country:US
Mailing Address - Phone:270-651-9390
Mailing Address - Fax:270-629-3156
Practice Address - Street 1:106 COLUMNS PLAZA DR
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-8068
Practice Address - Country:US
Practice Address - Phone:270-651-9390
Practice Address - Fax:270-629-3156
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100294280Medicaid