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General NPI Number Information
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NPI Number | 1417006826
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Entity Type | Individual
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Provider Name | KEN WHITLOW PT
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 54 LUMPKIN CAMPGROUND RD S STE 100
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City | DAWSONVILLE
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State | GA
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Zip | 30534-6197
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Country | US
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Telephone | 706-216-7910
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Fax |
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Provider Business Mailing Address
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Address Line | 5250 MILLSFORD CT
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City | CUMMING
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State | GA
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Zip | 30040-7478
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Country | US
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Telephone | 770-889-3357
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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 | 004873
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License Number State | GA
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