MEDICARE: MRS. WHITNEY ALLISON PATRICKSON PT

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	31438	FL

General Provider Information

NPI Number	:	1306294285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WHITNEY ALLISON PATRICKSON PT

Provider Business Mailing Address
First Line	:	48 OSPREY VILLAGE DR
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4955
Country	:	US
Telephone Number	:	904-491-1701
Fax Number	:	904-491-1702

Provider Business Practice Location Address
First Line	:	48 OSPREY VILLAGE DR
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4955
Country	:	US
Telephone Number	:	904-491-1701
Fax Number	:	904-491-1702

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

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	06/01/2016

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