Provider Demographics
NPI:1174763049
Name:HOUSEL, WHITNEY ALLISON
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ALLISON
Last Name:HOUSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 IRIS LN
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-3474
Mailing Address - Country:US
Mailing Address - Phone:217-994-3561
Mailing Address - Fax:
Practice Address - Street 1:1139 IRIS LN
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-3474
Practice Address - Country:US
Practice Address - Phone:217-994-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2665225200000X
IL160.005042225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant