Healthcare Provider Details

I. General information

NPI: 1407955164
Provider Name (Legal Business Name): MONICA JOANN WHITAKER PTA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8131 RITCHIE HWY SUITE E
PASADENA MD
21122-6940
US

IV. Provider business mailing address

3458 ANDREW CT APT 201
LAUREL MD
20724-2363
US

V. Phone/Fax

Practice location:
  • Phone: 410-590-4360
  • Fax: 410-590-4365
Mailing address:
  • Phone: 301-604-5446
  • Fax: 410-590-4365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA2986
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: