Basic Information
| Provider Information | |||||||||
| NPI: | 1124364328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITFIELD | ||||||||
| FirstName: | TERRI | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 MEADOWOOD ST | ||||||||
| Address2: | APARTMENT 232 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274092838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362855068 | ||||||||
| FaxNumber: | 3362855068 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 MEADOWOOD ST | ||||||||
| Address2: | APARTMENT 232 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274092838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362855068 | ||||||||
| FaxNumber: | 3362855068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2012 | ||||||||
| LastUpdateDate: | 12/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | A3405 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.