Provider Demographics
NPI:1780710855
Name:WHITTAKER PHYSICAL THERAPY WORKS, P.C.
Entity type:Organization
Organization Name:WHITTAKER PHYSICAL THERAPY WORKS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WHITTAKER
Authorized Official - Suffix:
Authorized Official - Credentials:P T
Authorized Official - Phone:217-440-3824
Mailing Address - Street 1:1671 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4258
Mailing Address - Country:US
Mailing Address - Phone:217-440-3824
Mailing Address - Fax:
Practice Address - Street 1:1671 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4258
Practice Address - Country:US
Practice Address - Phone:217-440-3824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00132042Medicare UPIN