Provider Demographics
NPI:1457743494
Name:WHITT, KIRSTEN ANNE (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ANNE
Last Name:WHITT
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 UNION RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-9138
Mailing Address - Country:US
Mailing Address - Phone:818-279-1088
Mailing Address - Fax:
Practice Address - Street 1:1248 MONTEREY ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3104
Practice Address - Country:US
Practice Address - Phone:805-541-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist