Healthcare Provider Details

I. General information

NPI: 1053335661
Provider Name (Legal Business Name): JESSE W WHITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 GLAMORGAN ST STE 110
ALLIANCE OH
44601-2938
US

IV. Provider business mailing address

75 GLAMORGAN ST STE 110
ALLIANCE OH
44601-2938
US

V. Phone/Fax

Practice location:
  • Phone: 330-821-2249
  • Fax: 330-821-9318
Mailing address:
  • Phone: 330-821-2249
  • Fax: 330-821-9318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-009178
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-008153
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-002099
License Number StateOH

VIII. Authorized Official

Name: MR. JESSE WILLIAM WHITE
Title or Position: OWNER/P.T.
Credential: P.T.
Phone: 330-821-2249