Provider Demographics
NPI:1962555383
Name:WHITAKER, JEFF DAVIS (PT, COS-C)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:DAVIS
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:PT, COS-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6006 LONESOME VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3748
Mailing Address - Country:US
Mailing Address - Phone:512-563-8005
Mailing Address - Fax:512-371-5303
Practice Address - Street 1:6006 LONESOME VALLEY TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3748
Practice Address - Country:US
Practice Address - Phone:512-563-8005
Practice Address - Fax:512-371-5303
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist