Provider Demographics
NPI:1417570292
Name:CARRIGAN, WHITNEY MARTINA (ATC)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MARTINA
Last Name:CARRIGAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25775 PIZZARO CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-7744
Mailing Address - Country:US
Mailing Address - Phone:951-323-1593
Mailing Address - Fax:
Practice Address - Street 1:25775 PIZZARO CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7744
Practice Address - Country:US
Practice Address - Phone:951-323-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000256672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2000025667Medicaid