Provider Demographics
NPI:1992572499
Name:WHITAKER RESTORATIVE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:WHITAKER RESTORATIVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-699-7379
Mailing Address - Street 1:7848 SW 61ST ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-9424
Mailing Address - Country:US
Mailing Address - Phone:541-699-7379
Mailing Address - Fax:
Practice Address - Street 1:813 SW HIGHLAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-3103
Practice Address - Country:US
Practice Address - Phone:541-699-7379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy