MEDICARE: JOSHUA WHITE MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	7571	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7571	OTHER	CO	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1184621237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA WHITE MPT

Provider Business Mailing Address
First Line	:	27118 MOUNTAIN PARK RD
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-5748
Country	:	US
Telephone Number	:	303-325-5329
Fax Number	:	303-670-3323

Provider Business Practice Location Address
First Line	:	3045 WHITMAN DR
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-2210
Country	:	US
Telephone Number	:	303-325-5329
Fax Number	:	303-670-3323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	02/01/2018

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