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General NPI Number Information
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NPI Number | 1902284912
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Entity Type | Individual
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Provider Name | CHANDRA WHITAKER DPT
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Gender | Female
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 10800 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505-3043
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Country | US
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Telephone | 833-574-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 22750 SHADOWRIDGE LN
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City | MORENO VALLEY
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State | CA
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Zip | 92557-2632
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Country | US
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Telephone |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 10766
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT297188
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License Number State | CA
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