Provider Demographics
NPI:1902884422
Name:WHITCOMB MEMORIAL PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:WHITCOMB MEMORIAL PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/P.T. ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-262-6974
Mailing Address - Street 1:PO BOX 530451
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75053-0451
Mailing Address - Country:US
Mailing Address - Phone:972-262-6974
Mailing Address - Fax:972-264-3073
Practice Address - Street 1:2705 HOSPITAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1017
Practice Address - Country:US
Practice Address - Phone:972-262-6974
Practice Address - Fax:972-264-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084CYOtherBLUE CROSS BLUE SHIELD
TX0084CYOtherBLUE CROSS BLUE SHIELD