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General NPI Number Information
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NPI Number | 1922498799
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Entity Type | Individual
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Provider Name | GLINDA WHITTAKER LPTA, LMT
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Gender | Female
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 4230 LAFAYETTE ST STE C
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City | MARIANNA
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State | FL
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Zip | 32446-8231
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Country | US
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Telephone | 850-526-1093
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Fax |
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Provider Business Mailing Address
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Address Line | 17352 MAIN ST N
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424-1763
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Country | US
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Telephone | 850-674-7639
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Fax | 850-674-4305
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA25146
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA30601
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License Number State | FL
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