Basic Information
| Provider Information | |||||||||
| NPI: | 1821464629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITTEMORE | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | DOUGLAS | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1865 FLINT HILL RD | ||||||||
| Address2: | |||||||||
| City: | LANDENBERG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193501513 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1651 PULASKI HWY | ||||||||
| Address2: | |||||||||
| City: | BEAR | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197011453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028341550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2015 | ||||||||
| LastUpdateDate: | 12/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | GA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | J1-0003615 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.