Provider Demographics
NPI:1700079803
Name:WHELAN, NANCY K (RPT, PA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:K
Last Name:WHELAN
Suffix:
Gender:F
Credentials:RPT, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6724 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3335
Mailing Address - Country:US
Mailing Address - Phone:561-433-2009
Mailing Address - Fax:561-433-1496
Practice Address - Street 1:6724 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-3335
Practice Address - Country:US
Practice Address - Phone:561-433-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY3653ZMedicare PIN