Healthcare Provider Details

I. General information

NPI: 1356369748
Provider Name (Legal Business Name): DAVID JAMES WHITFIELD MSPT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E 4TH ST
PORT ST JOE FL
32456-1760
US

IV. Provider business mailing address

502 E 4TH ST
PORT ST JOE FL
32456-1760
US

V. Phone/Fax

Practice location:
  • Phone: 850-227-7778
  • Fax: 850-227-7999
Mailing address:
  • Phone: 850-227-7778
  • Fax: 850-227-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 0010245
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT 0010245
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT 0010245
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT 0010245
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT 0010245
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 0010245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: