Provider Demographics
NPI:1548474992
Name:WHITTAKER, PAUL MICHAEL (MPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:WHITTAKER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 MADISON PARK DR
Mailing Address - Street 2:STE 100
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6355
Mailing Address - Country:US
Mailing Address - Phone:301-417-2652
Mailing Address - Fax:301-417-2653
Practice Address - Street 1:711 W 40TH ST STE 352
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2100
Practice Address - Country:US
Practice Address - Phone:410-243-5399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist