MEDICARE: JODI WHITE CPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	1404112	KS

General Provider Information

NPI Number	:	1013768571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI WHITE CPTA

Provider Business Mailing Address
First Line	:	819 OREGON ST
Second Line	:
City	:	HIAWATHA
State	:	KS
Zip	:	66434-2205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	819 OREGON ST
Second Line	:
City	:	HIAWATHA
State	:	KS
Zip	:	66434-2205
Country	:	US
Telephone Number	:	785-742-2201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	04/01/2024

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