MEDICARE: MAKAYLA WHITE PT, DPT

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	225100000X	Physical Therapist	6516	OK

General Provider Information

NPI Number	:	1285475814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKAYLA WHITE PT, DPT

Provider Business Mailing Address
First Line	:	2708 MUSTANG TRL
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73012-6673
Country	:	US
Telephone Number	:	405-315-1257
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 NW 39TH EXPY FL 3
Second Line	:
City	:	BETHANY
State	:	OK
Zip	:	73008-2868
Country	:	US
Telephone Number	:	405-981-4001
Fax Number	:

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

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/06/2024

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