Provider Demographics
NPI:1871715557
Name:WHITTEN, FLETA G (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:FLETA
Middle Name:G
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 CAMINO ALTO
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-1858
Mailing Address - Country:US
Mailing Address - Phone:830-964-5131
Mailing Address - Fax:
Practice Address - Street 1:555 FM 3237
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5311
Practice Address - Country:US
Practice Address - Phone:512-847-5540
Practice Address - Fax:512-847-0419
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1097087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1097087OtherPHYSICAL THERAPY LICENSE