Healthcare Provider Details

I. General information

NPI: 1518871862
Provider Name (Legal Business Name): PATRICK RIGGS GORDON WHITNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12164 CENTRAL AVE STE 212
MITCHELLVILLE MD
20721-1902
US

IV. Provider business mailing address

12760 BURCHARD DR SW
PORT ORCHARD WA
98367-7328
US

V. Phone/Fax

Practice location:
  • Phone: 240-929-4257
  • Fax:
Mailing address:
  • Phone: 360-551-7834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.P1.61581537
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: