Healthcare Provider Details

I. General information

NPI: 1740371731
Provider Name (Legal Business Name): JODI WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 KINGSLEY CT
FRANKENMUTH MI
48734-1270
US

IV. Provider business mailing address

1371 N KNIGHT RD
ESSEXVILLE MI
48732-9749
US

V. Phone/Fax

Practice location:
  • Phone: 989-793-2856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501008998
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: