MEDICARE: DR. BRANDON TYLER WHITWORTH 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	10299	TN

General Provider Information

NPI Number	:	1538431192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON TYLER WHITWORTH DPT

Provider Business Mailing Address
First Line	:	1511 JEFFERSON ST APT C
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37408-2115
Country	:	US
Telephone Number	:	631-790-9798
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 ADAMS ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37408
Country	:	US
Telephone Number	:	423-402-0778
Fax Number	:

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

Provider Enumeration Date	:	01/29/2012
Last Update Date	:	05/24/2018

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