MEDICARE: FLETA G. WHITTEN PHYSICAL THERAPIST

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	1097087	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1097087	OTHER	TX	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1871715557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLETA G. WHITTEN PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	1111 CAMINO ALTO
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-1858
Country	:	US
Telephone Number	:	830-964-5131
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 FM 3237
Second Line	:
City	:	WIMBERLEY
State	:	TX
Zip	:	78676-5311
Country	:	US
Telephone Number	:	512-847-5540
Fax Number	:	512-847-0419

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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