Basic Information
| Provider Information | |||||||||
| NPI: | 1285281766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHELAN | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5913 OAKLAND RD | ||||||||
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| City: | HALETHORPE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212274331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318353257 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9109 LIBERTY RD | ||||||||
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| City: | RANDALLSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211333521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106557373 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2019 | ||||||||
| LastUpdateDate: | 08/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | A5222 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.