Healthcare Provider Details

I. General information

NPI: 1124955620
Provider Name (Legal Business Name): ROBERT N WHITEHURST II M.ED, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 E WOOSTER ST
BOWLING GREEN OH
43403-4046
US

IV. Provider business mailing address

1535 E WOOSTER ST STROH CENTER - ATHLETIC TRAINING ROOM
BOWLING GREEN OH
43403-4046
US

V. Phone/Fax

Practice location:
  • Phone: 419-372-2219
  • Fax: 419-372-0123
Mailing address:
  • Phone: 419-372-2219
  • Fax: 419-372-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT003664
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: