Basic Information
| Provider Information | |||||||||
| NPI: | 1689279119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITLOCK | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14287 N 87TH ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852603698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025599707 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3500 12TH AVE NW | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058814179 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2020 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.