Provider Demographics
NPI:1992789705
Name:WHITNEY, RICHARD KEVIN (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:KEVIN
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 UNION ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1166
Mailing Address - Country:US
Mailing Address - Phone:814-670-0534
Mailing Address - Fax:814-670-0653
Practice Address - Street 1:22685 ROUTE 68
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-4019
Practice Address - Country:US
Practice Address - Phone:814-223-4090
Practice Address - Fax:814-223-4092
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012709L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA234209OtherMEDICARE PTAN
PA761642OtherBCBS
PA761642OtherBCBS