Provider Demographics
NPI:1023613312
Name:WHITEHOUSE, ANNAMARIE (PTA)
Entity type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ANNAMARIE
Other - Middle Name:
Other - Last Name:SOUZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1224 CHELSEA ST
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5124
Mailing Address - Country:US
Mailing Address - Phone:469-354-5517
Mailing Address - Fax:
Practice Address - Street 1:800 COLLEGE PKWY APT 336
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-3505
Practice Address - Country:US
Practice Address - Phone:972-420-8543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant