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NPI Code Detail

MEDICARE: JILL WHITE PT

MEDICARE: JILL WHITE PT
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
1225100000XPhysical Therapist024532-1NY

General Provider Information

NPI Number : 1184791295
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL WHITE PT
Provider Business Mailing Address
First Line : 2460 VICTORY BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-6612
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2460 VICTORY BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-6612
Country : US
Telephone Number : 917-647-5275
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 09/07/2010

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Directions to “ JILL WHITE PT” Practice Location

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