Healthcare Provider Details

I. General information

NPI: 1578292413
Provider Name (Legal Business Name): WHITE'S FITNESS & REHABILITATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5302 W VILLAGE PKWY STE 1
ROGERS AR
72758-8139
US

IV. Provider business mailing address

1421 ALLENS MILL WAY
CAVE SPRINGS AR
72718-5034
US

V. Phone/Fax

Practice location:
  • Phone: 620-660-2852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERIN WHITE
Title or Position: PT, DPT
Credential: PT, DPT
Phone: 620-660-2852