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NPI Code Detail

MEDICARE: MR. MATTHEW DAVID WHITE PT

MEDICARE: MR. MATTHEW DAVID WHITE PT
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 TherapistPT 18157FL

General Provider Information

NPI Number : 1790024412
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW DAVID WHITE PT
Provider Business Mailing Address
First Line : 311 EVENTIDE DR
Second Line :
City : FLEMING ISLAND
State : FL
Zip : 32003-8187
Country : US
Telephone Number : 904-215-8046
Fax Number : 904-215-9960
Provider Business Practice Location Address
First Line : 1215 KINGSLEY AVE
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-4631
Country : US
Telephone Number : 904-269-8922
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2013
Last Update Date : 02/01/2013

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Directions to “ MR. MATTHEW DAVID WHITE PT” Practice Location

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