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General NPI Number Information
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NPI Number | 1215562483
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Entity Type | Individual
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Provider Name | BOBBY JOE WHITE III PT,DPT
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Gender | Male
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Dates
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Enumeration Date | 03/09/2020
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 2711 N GRANDVIEW AVE
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City | ODESSA
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State | TX
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Zip | 79762-6952
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Country | US
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Telephone | 432-279-1401
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Fax |
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Provider Business Mailing Address
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Address Line | 5147 37TH ST
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City | DICKINSON
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State | TX
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Zip | 77539-5907
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Country | US
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Telephone | 832-279-7374
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1328342
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License Number State | TX
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