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General NPI Number Information
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NPI Number | 1992528012
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Entity Type | Individual
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Provider Name | WILLIAM WHITLOCK
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Gender | Male
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 4227 US HIGHWAY 98 N
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City | LAKELAND
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State | FL
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Zip | 33809-3817
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Country | US
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Telephone | 863-937-3346
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Fax |
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Provider Business Mailing Address
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Address Line | 7828 NW 35TH PL
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City | GAINESVILLE
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State | FL
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Zip | 32606-5680
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Country | US
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Telephone | 954-806-9811
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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 | PT41977
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License Number State | FL
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