Healthcare Provider Details

I. General information

NPI: 1912401969
Provider Name (Legal Business Name): CATHY SUZETTE WHITAKER P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 EAST MAIN STREET
LEXINGTON KY
40502
US

IV. Provider business mailing address

710 EAST MAIN STREET
LEXINGTON KY
40502
US

V. Phone/Fax

Practice location:
  • Phone: 859-629-6106
  • Fax: 859-422-6712
Mailing address:
  • Phone: 859-629-6106
  • Fax: 859-422-6712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number003854
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number003854
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: