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General NPI Number Information
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NPI Number | 1568796084
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Entity Type | Individual
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Provider Name | TIMOTHY J WHITAKER D.P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2009
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 6017A FASHION POINT DR
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4851
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Country | US
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Telephone | 801-317-1618
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Fax | 801-459-3707
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Provider Business Mailing Address
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Address Line | 6017A FASHION POINT DR
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4851
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Country | US
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Telephone | 801-317-1618
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Fax | 801-459-3707
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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 | 7420114-2401
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License Number State | UT
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