Provider Demographics
NPI:1154020386
Name:WHALEN, MATTHEW CARTER (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CARTER
Last Name:WHALEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 RIDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5200
Mailing Address - Country:US
Mailing Address - Phone:859-271-3034
Mailing Address - Fax:
Practice Address - Street 1:4324 RIDGEWATER DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-5200
Practice Address - Country:US
Practice Address - Phone:859-271-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYW13-380-025OtherDRIVERS LICENSE