Provider Demographics
NPI:1831772284
Name:WHITTLE, DESTANIE ANN
Entity type:Individual
Prefix:
First Name:DESTANIE
Middle Name:ANN
Last Name:WHITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CURRANT TRCE
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-2188
Mailing Address - Country:US
Mailing Address - Phone:918-868-7834
Mailing Address - Fax:
Practice Address - Street 1:355 CURRANT TRCE
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-2188
Practice Address - Country:US
Practice Address - Phone:918-868-7834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA31087225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA31087OtherFLORIDA LICENSE NUMBER