Individual
CHARLES DERRICK WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
695 HIGHWAY 15 N STE 3, JACKSON, KY 41339-7005
(606) 666-9293
Mailing address
258 PARK RD, JACKSON, KY 41339-9638
(606) 568-5724
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
005707
KY
Other
Enumeration date
12/22/2010
Last updated
12/22/2010
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