Healthcare Provider Details

I. General information

NPI: 1063246791
Provider Name (Legal Business Name): ROBBIE WHITTAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 WILMA RUDOLPH BLVD STE H
CLARKSVILLE TN
37040-8453
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 931-552-4846
  • Fax:
Mailing address:
  • Phone: 423-933-1260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15957
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: