Healthcare Provider Details

I. General information

NPI: 1780845487
Provider Name (Legal Business Name): MARIE ELIZABETH WHITAKER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N LOCUST ST
SISTERS OR
97759-5047
US

IV. Provider business mailing address

PO BOX 1911
SISTERS OR
97759-1911
US

V. Phone/Fax

Practice location:
  • Phone: 541-549-3534
  • Fax: 541-549-1272
Mailing address:
  • Phone: 541-549-3534
  • Fax: 541-549-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5652
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: