MEDICARE: JEFFREY BRYAN WHITAKER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1310937	TX

General Provider Information

NPI Number	:	1013490515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY BRYAN WHITAKER DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 NORTHWEST HWY
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-5834
Country	:	US
Telephone Number	:	469-630-6700
Fax Number	:	214-234-9337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2018
Last Update Date	:	01/25/2023

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