Healthcare Provider Details

I. General information

NPI: 1255438503
Provider Name (Legal Business Name): DONALD W WHITE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N US HIGHWAY 89
PRESCOTT AZ
86313-5001
US

IV. Provider business mailing address

750 NORTHWOOD LOOP
PRESCOTT AZ
86303-5317
US

V. Phone/Fax

Practice location:
  • Phone: 928-717-7493
  • Fax:
Mailing address:
  • Phone: 928-778-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0473
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: