Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 070023071 | IL |
NPI | 1336760529 |
---|---|
Provider Name | Dr. Max Whiting |
First Address | Chicago, IL 60607-5016 |
Second Address | Chicago, IL 60607-5016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2020 |
Last Update Date | 29/04/2020 |