Provider Demographics
NPI:1336760024
Name:WHITMAN, DYLAN WALKER (PTA)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:WALKER
Last Name:WHITMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 DESSAU RD APT 1022
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-1890
Mailing Address - Country:US
Mailing Address - Phone:832-928-6732
Mailing Address - Fax:
Practice Address - Street 1:8324 CAMERON RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-3990
Practice Address - Country:US
Practice Address - Phone:737-241-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2110296225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant