Provider Demographics
NPI:1316262900
Name:WHITTINGTON, GENA CHURCH (PT)
Entity type:Individual
Prefix:MS
First Name:GENA
Middle Name:CHURCH
Last Name:WHITTINGTON
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 1:405 HAWKS NEST TRL
Mailing Address - Street 2:
Mailing Address - City:PURLEAR
Mailing Address - State:NC
Mailing Address - Zip Code:28665-9354
Mailing Address - Country:US
Mailing Address - Phone:336-909-5884
Mailing Address - Fax:
Practice Address - Street 1:405 HAWKS NEST TRL
Practice Address - Street 2:
Practice Address - City:PURLEAR
Practice Address - State:NC
Practice Address - Zip Code:28665-9354
Practice Address - Country:US
Practice Address - Phone:336-909-5884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2348174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist