Healthcare Provider Details

I. General information

NPI: 1972893592
Provider Name (Legal Business Name): JOCELYN JEAN WHITE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 OLD ROUTE 18
WAMPUM PA
16157-2909
US

IV. Provider business mailing address

1061 OLD ROUTE 18
WAMPUM PA
16157-2909
US

V. Phone/Fax

Practice location:
  • Phone: 724-535-6018
  • Fax:
Mailing address:
  • Phone: 724-535-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT020996
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: