Healthcare Provider Details

I. General information

NPI: 1801578323
Provider Name (Legal Business Name): MACY WHITEHAIR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 PILGRIM BLVD
HARTFORD CITY IN
47348-1382
US

IV. Provider business mailing address

410 PILGRIM BLVD
HARTFORD CITY IN
47348-1382
US

V. Phone/Fax

Practice location:
  • Phone: 765-348-4197
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05015217A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: