Healthcare Provider Details

I. General information

NPI: 1144361130
Provider Name (Legal Business Name): JOHN MARK WHITE PT, DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 NW 120TH CT
OKLAHOMA CITY OK
73162-1729
US

IV. Provider business mailing address

6006 NW 120TH CT
OKLAHOMA CITY OK
73162-1729
US

V. Phone/Fax

Practice location:
  • Phone: 405-773-0442
  • Fax: 405-773-0446
Mailing address:
  • Phone: 405-773-0442
  • Fax: 405-773-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2405
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: