Provider Demographics
NPI:1932228673
Name:WHITNEY, KAYE (PT)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:
Last Name:WHITNEY
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 1:21842 LYONS BALD MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8768
Mailing Address - Country:US
Mailing Address - Phone:209-533-4398
Mailing Address - Fax:
Practice Address - Street 1:14520 MONO WAY, SUITE 130
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-533-1273
Practice Address - Fax:209-533-1382
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist