Provider Demographics
NPI:1962460477
Name:WHITEHEAD, DARLA GAY (PT)
Entity type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:GAY
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DARLA
Other - Middle Name:GAY
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:203 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134
Mailing Address - Country:US
Mailing Address - Phone:540-599-0299
Mailing Address - Fax:
Practice Address - Street 1:203 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134
Practice Address - Country:US
Practice Address - Phone:540-599-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
275108OtherMAMSI
7526392OtherAETNA
460250OtherANTHEM BCBS