MEDICARE: MRS. DORI M WHITE LMT

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	172M00000X	Mechanotherapist	6904	OR

General Provider Information

NPI Number	:	1063645372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DORI M WHITE LMT

Provider Business Mailing Address
First Line	:	9955 SE WASHINGTON ST
Second Line	:	SUITE #320
City	:	PORTLAND
State	:	OR
Zip	:	97216-2439
Country	:	US
Telephone Number	:	503-957-3696
Fax Number	:	503-253-0377

Provider Business Practice Location Address
First Line	:	9955 SE WASHINGTON ST
Second Line	:	SUITE #320
City	:	PORTLAND
State	:	OR
Zip	:	97216-2439
Country	:	US
Telephone Number	:	503-957-3696
Fax Number	:	503-253-0377

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

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	09/02/2009

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