Healthcare Provider Details

I. General information

NPI: 1033104914
Provider Name (Legal Business Name): EMMA W WHITE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319A JULIAN AVE HEALTHCARE CONSULTANTS INC
THOMASVILLE NC
27360-4832
US

IV. Provider business mailing address

1262 DOVERSHIRE CT
HIGH POINT NC
27262-7306
US

V. Phone/Fax

Practice location:
  • Phone: 336-472-6566
  • Fax: 336-472-5281
Mailing address:
  • Phone: 336-882-6035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3573
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: