MEDICARE: BEN WHITE PHYSIOTHERAPY

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1912405606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEN WHITE PHYSIOTHERAPY

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	:	OWNER
Name	:	BENJAMIN WHITE
Credential	:	PT, DPT
Telephone Number	:	812-361-6212

Provider Enumeration Date	:	01/27/2018
Last Update Date	:	04/30/2018

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Directions to “BEN WHITE PHYSIOTHERAPY ” Practice Location

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