Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT1479 | OK |
NPI | 1003121773 |
---|---|
Provider Name | Mr. Joe Kent Whitt |
First Address | Shawnee, OK 74804-3501 |
Second Address | Shawnee, OK 74804-3501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2010 |
Last Update Date | 18/08/2010 |