Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 0010245 | FL |
N | 2251G0304X | Physical Therapist - Geriatrics | PT 0010245 | FL |
N | 2251N0400X | Physical Therapist - Neurology | PT 0010245 | FL |
N | 2251P0200X | Physical Therapist - Pediatrics | PT 0010245 | FL |
N | 2251S0007X | Physical Therapist - Sports | PT 0010245 | FL |
N | 2251X0800X | Physical Therapist - Orthopedic | PT 0010245 | FL |
NPI | 1356369748 |
---|---|
Provider Name | Dr. David James Whitfield |
First Address | Port St Joe, FL 32456-1760 |
Second Address | Port St Joe, FL 32456-1760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 22/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y8346 | BLUE CROSS / BLUE SHIELD (01) | FL |