MEDICARE: CHRISTOPHER J WHITE

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	2255A2300X	Athletic Trainer		FL
2	171400000X	Health & Wellness Coach		FL

General Provider Information

NPI Number	:	1205620986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER J WHITE

Provider Business Mailing Address
First Line	:	100 BEACH DR APT 2
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2663
Country	:	US
Telephone Number	:	850-687-6594
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 BEACH DR APT 2
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2663
Country	:	US
Telephone Number	:	850-687-6594
Fax Number	:

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

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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