Healthcare Provider Details

I. General information

NPI: 1932019528
Provider Name (Legal Business Name): MATTHEW WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 N REYNOLDS RD, BRYANT, AR 72022
BRYANT AR
72202
US

IV. Provider business mailing address

3757 PROMISE LAND RD
LITTLE ROCK AR
72206-8858
US

V. Phone/Fax

Practice location:
  • Phone: 501-313-0592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5155
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: