Provider Demographics
NPI:1104063973
Name:WHITTAKER, RACHEL MARIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MARIE
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 10TH WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6618
Mailing Address - Country:US
Mailing Address - Phone:561-427-8512
Mailing Address - Fax:
Practice Address - Street 1:3450 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1707
Practice Address - Country:US
Practice Address - Phone:561-625-2775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21473225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant