Healthcare Provider Details

I. General information

NPI: 1083722268
Provider Name (Legal Business Name): SEAN THOMAS WHITE DPT, OCS, CMDT, COMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 N 200 E
COLUMBIA CITY IN
46725-8895
US

IV. Provider business mailing address

169 N 200 E
COLUMBIA CITY IN
46725-8895
US

V. Phone/Fax

Practice location:
  • Phone: 260-244-5133
  • Fax: 260-255-5134
Mailing address:
  • Phone: 260-244-5133
  • Fax: 260-244-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05007643A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: