MEDICARE: HEATHER MARIE 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
1	225100000X	Physical Therapist	05012304A	IN

General Provider Information

NPI Number	:	1790003382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MARIE WHITE PT, DPT

Provider Business Mailing Address
First Line	:	169 N 200 E
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-8895
Country	:	US
Telephone Number	:	260-244-5133
Fax Number	:	260-244-5134

Provider Business Practice Location Address
First Line	:	169 N 200 E
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-8895
Country	:	US
Telephone Number	:	260-244-5133
Fax Number	:	260-244-5134

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

Provider Enumeration Date	:	05/07/2010
Last Update Date	:	01/31/2017

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