Basic Information
| Provider Information | |||||||||
| NPI: | 1144635772 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHATLEY | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | LANDRENEAU | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1908 FLINT RD SE | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356016031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563409708 | ||||||||
| FaxNumber: | 2563409624 | ||||||||
| Practice Location | |||||||||
| Address1: | 513 ACADEMY RD | ||||||||
| Address2: | |||||||||
| City: | STARKVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397594021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622688013 | ||||||||
| FaxNumber: | 6622688095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2014 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | PTH7174 | AL | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 225100000X | PT5930 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 529917620 | 05 | AL | MEDICAID | 1003819608 | 01 | AL | GROUP NPI | OTHER |