Provider Demographics
NPI:1497302244
Name:WEBORG, WHITNEY MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MARIE
Last Name:WEBORG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:MARIE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1199 LANARK ROAD
Mailing Address - Street 2:
Mailing Address - City:OVID
Mailing Address - State:ID
Mailing Address - Zip Code:83254
Mailing Address - Country:US
Mailing Address - Phone:208-908-9526
Mailing Address - Fax:
Practice Address - Street 1:164 S 5TH STREET
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:ID
Practice Address - Zip Code:83254
Practice Address - Country:US
Practice Address - Phone:208-847-4417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2031225100000X
UT13908430-2401225100000X
IDPT-9200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist