Individual
COLLEEN M WHITEFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
171 E SPRINGBROOK RD, BROADWAY, VA 22815-9526
(540) 901-9501
(540) 901-8773
Mailing address
171 E SPRINGBROOK RD, BROADWAY, VA 22815-9526
(540) 901-9501
(540) 828-6583
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2305002987
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
194034
ANTHEM PROVIDER NUMBER
VA
Enumeration date
10/17/2005
Last updated
03/21/2017
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