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General NPI Number Information
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NPI Number | 1154020386
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Entity Type | Individual
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Provider Name | MATTHEW CARTER WHALEN DPT
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Gender | Male
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 4324 RIDGEWATER DR
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City | LEXINGTON
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State | KY
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Zip | 40515-5200
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Country | US
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Telephone | 859-271-3034
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Fax |
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Provider Business Mailing Address
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Address Line | 4324 RIDGEWATER DR
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City | LEXINGTON
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State | KY
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Zip | 40515-5200
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Country | US
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Telephone | 859-271-3034
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 008625
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License Number State | KY
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