MEDICARE: DAMON CRAIG WHITFIELD PT, ATC

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	2255A2300X	Athletic Trainer	120002030
2	225100000X	Physical Therapist	5501011595	MI

General Provider Information

NPI Number	:	1568505972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMON CRAIG WHITFIELD PT, ATC

Provider Business Mailing Address
First Line	:	3277 NEEDLES DR
Second Line	:
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-8796
Country	:	US
Telephone Number	:	231-526-2186
Fax Number	:

Provider Business Practice Location Address
First Line	:	3277 NEEDLES DR
Second Line	:
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-8796
Country	:	US
Telephone Number	:	231-526-2186
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	08/12/2015

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