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General NPI Number Information
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NPI Number | 1962130831
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Entity Type | Individual
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Provider Name | DAVID MICHAEL WHITTLE DPT
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Gender | Male
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 3928 PACIFIC AVE SE
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City | LACEY
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State | WA
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Zip | 98503-1109
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Country | US
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Telephone | 360-455-1350
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Fax |
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Provider Business Mailing Address
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Address Line | 1647 91ST AVE SW
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City | OLYMPIA
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State | WA
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Zip | 98512-7705
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Country | US
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Telephone | 360-481-6067
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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 | PT61318365
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License Number State | WA
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