Healthcare Provider Details

I. General information

NPI: 1639722754
Provider Name (Legal Business Name): WHITNEY MCDANIEL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 W HIGHWAY 92
WILLIAMSBURG KY
40769-1936
US

IV. Provider business mailing address

312 PONDEROSA TRL
CORBIN KY
40701-8590
US

V. Phone/Fax

Practice location:
  • Phone: 606-539-7257
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA03480
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: