Provider Demographics
NPI:1154352490
Name:WHITBY, DANIEL THOMAS
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:THOMAS
Last Name:WHITBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 WYOMING BLVD NE
Mailing Address - Street 2:STE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6020
Mailing Address - Country:US
Mailing Address - Phone:505-821-6715
Mailing Address - Fax:505-821-0839
Practice Address - Street 1:5800 CAMP BOWIE BLVD
Practice Address - Street 2:SUITE 126
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5057
Practice Address - Country:US
Practice Address - Phone:817-870-2500
Practice Address - Fax:817-870-1382
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50702237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist