Provider Demographics
NPI:1396354429
Name:ANDERSON, WHITNEY (PTA)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
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:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:MYRA
Mailing Address - State:KY
Mailing Address - Zip Code:41549-0187
Mailing Address - Country:US
Mailing Address - Phone:606-639-8624
Mailing Address - Fax:
Practice Address - Street 1:945 W RUSSELL ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:KY
Practice Address - Zip Code:41522
Practice Address - Country:US
Practice Address - Phone:606-754-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant