Provider Demographics
NPI:1457198681
Name:HERRIN, WHITLEY (PTA)
Entity type:Individual
Prefix:
First Name:WHITLEY
Middle Name:
Last Name:HERRIN
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 1:134 JAMESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:DESHA
Mailing Address - State:AR
Mailing Address - Zip Code:72527-9001
Mailing Address - Country:US
Mailing Address - Phone:870-834-1207
Mailing Address - Fax:
Practice Address - Street 1:711 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:AR
Practice Address - Zip Code:72521-9103
Practice Address - Country:US
Practice Address - Phone:870-283-5391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA4941225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant