=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154432722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA R WHITE DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2102 HARVELL CIRCLE
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-293-5500
-----------------------------------------------------
Fax | 402-293-5505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6404 NORTH 70TH PLAZA
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-573-3700
-----------------------------------------------------
Fax | 402-573-3790
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2271
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------