MEDICARE: MISS AMY CATHERINE WHITTEN 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	2305205124	VA

General Provider Information

NPI Number	:	1750687075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMY CATHERINE WHITTEN DPT

Provider Business Mailing Address
First Line	:	4627 KENSINGTON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1310
Country	:	US
Telephone Number	:	804-592-9676
Fax Number	:

Provider Business Practice Location Address
First Line	:	4627 KENSINGTON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1310
Country	:	US
Telephone Number	:	804-592-9676
Fax Number	:

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

Provider Enumeration Date	:	02/03/2011
Last Update Date	:	02/03/2011

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