1265714364 NPI number — DR. WHITNEY BROOKE DEWEESE PT, DPT

Table of content: DR. WHITNEY BROOKE DEWEESE PT, DPT (NPI 1265714364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265714364 NPI number — DR. WHITNEY BROOKE DEWEESE PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEWEESE
Provider First Name:
WHITNEY
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGUFFEY
Provider Other First Name:
WHITNEY
Provider Other Middle Name:
BROOKE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265714364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4101 TATES CREEK CENTRE DR
Provider Second Line Business Mailing Address:
STE 144
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40517-3066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-217-2887
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 TATES CREEK CENTRE DR
Provider Second Line Business Practice Location Address:
STE 144
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40517-3066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-217-2887
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  005898 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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