Healthcare Provider Details

I. General information

NPI: 1407522568
Provider Name (Legal Business Name): ANNA MAYSN WHITTEN MSAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 HYDRAULIC RIDGE RD STE 4
CHARLOTTESVILLE VA
22901-8126
US

IV. Provider business mailing address

200 CROCKETT CIR APT 211
CHARLOTTESVILLE VA
22911-8346
US

V. Phone/Fax

Practice location:
  • Phone: 434-544-8100
  • Fax:
Mailing address:
  • Phone: 434-906-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217950
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: