MEDICARE: MIKAYLEE WHALEN 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	053186	NY

General Provider Information

NPI Number	:	1679300123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAYLEE WHALEN DPT

Provider Business Mailing Address
First Line	:	703 GRANITE ST STE 3
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-5350
Country	:	US
Telephone Number	:	781-961-3370
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 MAIN ST
Second Line	:
City	:	CAMDEN
State	:	NY
Zip	:	13316-1301
Country	:	US
Telephone Number	:	315-245-5286
Fax Number	:

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

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	09/18/2024

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Directions to “ MIKAYLEE WHALEN DPT” Practice Location

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