Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT6026 | ME |
NPI | 1467104687 |
---|---|
Provider Name | Nathaniel Parker Whitten |
First Address | Saco, ME 04072-2891 |
Second Address | Saco, ME 04072-2891 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2022 |
Last Update Date | 19/01/2022 |