Healthcare Provider Details

I. General information

NPI: 1689601247
Provider Name (Legal Business Name): TIMOTHY MICHAEL WHITE ATC, LAT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9019 OVERLOOK BLVD STE C2
BRENTWOOD TN
37027-2750
US

IV. Provider business mailing address

1004 MCCUTCHAN CT
SPRING HILL TN
37174-6159
US

V. Phone/Fax

Practice location:
  • Phone: 734-731-4972
  • Fax:
Mailing address:
  • Phone: 734-731-4972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: