MEDICARE: MR. ROBERT BRENT WHALIN M.S. P.T.

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	1132165	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T4323	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1205834330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT BRENT WHALIN M.S. P.T.

Provider Business Mailing Address
First Line	:	2501 W WILLIAM CANNON DR
Second Line	:	SUITE 401
City	:	AUSTIN
State	:	TX
Zip	:	78745-5253
Country	:	US
Telephone Number	:	512-416-7246
Fax Number	:	512-416-6791

Provider Business Practice Location Address
First Line	:	2501 W WILLIAM CANNON DR
Second Line	:	SUITE 302
City	:	AUSTIN
State	:	TX
Zip	:	78745-5253
Country	:	US
Telephone Number	:	512-416-7246
Fax Number	:	512-416-6791

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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