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NPI Code Detail

MEDICARE: RANDY WHITTLE

MEDICARE: RANDY WHITTLE
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1164454047
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDY WHITTLE
Provider Business Mailing Address
First Line : PO BOX 597
Second Line :
City : TAYLOR
State : AZ
Zip : 85939-0597
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2500 E HUNT ST
Second Line :
City : SHOW LOW
State : AZ
Zip : 85901-7954
Country : US
Telephone Number : 928-537-6532
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 07/08/2007

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Directions to “ RANDY WHITTLE ” Practice Location

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