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General NPI Number Information
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NPI Number | 1457311201
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Entity Type | Individual
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Provider Name | SUSAN WHITE P.T.
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Gender | Female
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 11/25/2007
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Provider Practice Location Address
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Address Line | 12 COURNOYER ROAD
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City | WEST TISBURY
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State | MA
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Zip | 02575
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Country | US
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Telephone | 508-693-5949
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Fax | 508-693-5942
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Provider Business Mailing Address
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Address Line | PO BOX 547
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City | WEST TISBURY
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State | MA
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Zip | 02575-0547
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Country | US
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Telephone | 508-693-5949
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4766
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License Number State | MA
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