Healthcare Provider Details

I. General information

NPI: 1457528002
Provider Name (Legal Business Name): ROBERT L WHITE JR. CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 B ST SE #3
WASHINGTON DC
20019-4362
US

IV. Provider business mailing address

4444 B ST SE #3
WASHINGTON DC
20019-4362
US

V. Phone/Fax

Practice location:
  • Phone: 301-675-0001
  • Fax:
Mailing address:
  • Phone: 301-675-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019006781
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT1016
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: