Provider Demographics
NPI:1770524498
Name:WHITESIDE, LILLA B (PT)
Entity type:Individual
Prefix:
First Name:LILLA
Middle Name:B
Last Name:WHITESIDE
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 1:3428 N ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4224
Mailing Address - Country:US
Mailing Address - Phone:305-295-9797
Mailing Address - Fax:305-295-9796
Practice Address - Street 1:10518 SPOTSYLVANIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2693
Practice Address - Country:US
Practice Address - Phone:540-710-5341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0188ZMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER
FL38363Medicare ID - Type UnspecifiedGROUP NUMBER