Individual
MICHAEL ANTHONY WHITING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
850 W IRONWOOD DR, STE 103, COEUR D ALENE, ID 83814-4903
(208) 664-1119
(208) 765-4340
Mailing address
PO BOX 609, HAYDEN, ID 83835-0609
(208) 664-1119
(208) 765-4340
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT-1912
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807065400
—
ID
Enumeration date
06/27/2005
Last updated
06/08/2016
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