Provider Demographics
NPI:1780327106
Name:ANDERSON GONZALEZ, WHITNEY J (DPT)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:J
Last Name:ANDERSON GONZALEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:J
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2025 NE BAKER ST STE A
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-2656
Mailing Address - Country:US
Mailing Address - Phone:503-435-1900
Mailing Address - Fax:503-435-1930
Practice Address - Street 1:2025 NE BAKER ST STE A
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2656
Practice Address - Country:US
Practice Address - Phone:503-435-1900
Practice Address - Fax:503-435-1930
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist