1629370234 NPI number — DR. JOE DAVID WHITTEMORE II PT, DPT, SCS

Table of content: DR. JOE DAVID WHITTEMORE II PT, DPT, SCS (NPI 1629370234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629370234 NPI number — DR. JOE DAVID WHITTEMORE II PT, DPT, SCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITTEMORE
Provider First Name:
JOE
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
PT, DPT, SCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629370234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 WESTBANK DR
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
WEST LAKE HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78746-6547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-306-8071
Provider Business Mailing Address Fax Number:
512-306-8518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 WESTBANK DR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
WEST LAKE HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-6547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-306-8071
Provider Business Practice Location Address Fax Number:
512-306-8518
Provider Enumeration Date:
12/02/2010

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:  1200743 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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