Healthcare Provider Details

I. General information

NPI: 1578566428
Provider Name (Legal Business Name): DOUGLAS M WHITE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 05/14/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55-3435 AKONI PULE HWY #7
HAWI HI
96719
US

IV. Provider business mailing address

54-396 UNION MILL RD UNIT 1179
KAPAAU HI
96755-3050
US

V. Phone/Fax

Practice location:
  • Phone: 617-696-1974
  • Fax:
Mailing address:
  • Phone: 808-796-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5659
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT-5025
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: