Provider Demographics
NPI:1649262940
Name:WHITWORTH, PAMELA ANNE (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:WHITWORTH
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 1:3201 W LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1808
Mailing Address - Country:US
Mailing Address - Phone:850-385-3612
Mailing Address - Fax:
Practice Address - Street 1:1965 CAPITAL CIR NE
Practice Address - Street 2:STE 200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8402
Practice Address - Country:US
Practice Address - Phone:850-656-2006
Practice Address - Fax:850-656-2820
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 5678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y8802OtherBCBS FL
Y8802OtherBCBS FL