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NPI Code Detail

MEDICARE: MRS. MICHELE RENEE WHITEHEAD P.T.

MEDICARE: MRS. MICHELE RENEE WHITEHEAD 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
1225100000XPhysical Therapist1166530TX

General Provider Information

NPI Number : 1366641037
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELE RENEE WHITEHEAD P.T.
Provider Business Mailing Address
First Line : 3026 NW 28TH CIR
Second Line :
City : GAINESVILLE
State : FL
Zip : 32605-2983
Country : US
Telephone Number : 352-562-1166
Fax Number :
Provider Business Practice Location Address
First Line : 333 1ST ST N
Second Line : SUITE 200
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-6945
Country : US
Telephone Number : 904-241-9231
Fax Number : 877-420-5038
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2007
Last Update Date : 07/13/2007

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