Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA003598 | GA |
N | 225200000X | Physical Therapy Assistant | PTA23786 | FL |
NPI | 1013457076 |
---|---|
Provider Name | Christina Michelle Whigham |
First Address | Saint Marys, GA 31558-3421 |
Second Address | Folkston, GA 31537-4643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2017 |
Last Update Date | 24/02/2017 |