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NPI Code Detail

MEDICARE: BENJAMIN A WHITE PT, DPT

MEDICARE: BENJAMIN A WHITE PT, DPT
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
1225100000XPhysical Therapist22202MA
2225100000XPhysical Therapist292009CA
3225100000XPhysical TherapistPT017332OH

General Provider Information

NPI Number : 1407215528
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN A WHITE PT, DPT
Provider Business Mailing Address
First Line : 2516 FAIRWOOD CT
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-1765
Country : US
Telephone Number : 812-361-6212
Fax Number :
Provider Business Practice Location Address
First Line : 2516 FAIRWOOD CT
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-1765
Country : US
Telephone Number : 812-361-6212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2016
Last Update Date : 04/30/2018

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