Provider Demographics
NPI:1386903250
Name:WILSON BANG, WHITNEY
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:
Last Name:WILSON BANG
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:WHITNEY
Other - Middle Name:BLAIR
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:211 STAMPEDE ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-8794
Mailing Address - Country:US
Mailing Address - Phone:214-929-2062
Mailing Address - Fax:
Practice Address - Street 1:507 N HIGHWAY 77
Practice Address - Street 2:700
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1885
Practice Address - Country:US
Practice Address - Phone:972-938-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12039292251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20089581OtherDRIVERS LICENSE