Provider Demographics
NPI:1396576047
Name:WHALEY, ORRIN DOMINGO (DPT)
Entity type:Individual
Prefix:
First Name:ORRIN
Middle Name:DOMINGO
Last Name:WHALEY
Suffix:
Gender:M
Credentials:DPT
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 552
Mailing Address - Street 2:
Mailing Address - City:KAYENTA
Mailing Address - State:AZ
Mailing Address - Zip Code:86033-0552
Mailing Address - Country:US
Mailing Address - Phone:801-361-2390
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 552
Practice Address - Street 2:
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033-0552
Practice Address - Country:US
Practice Address - Phone:801-361-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13971007-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist