MEDICARE: REBECCA MAE WHITE 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	12827	OH

General Provider Information

NPI Number	:	1316267628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MAE WHITE DPT

Provider Business Mailing Address
First Line	:	108 GLOVER DR
Second Line	:
City	:	MOUNT ORAB
State	:	OH
Zip	:	45154-8390
Country	:	US
Telephone Number	:	937-444-2933
Fax Number	:	937-444-2924

Provider Business Practice Location Address
First Line	:	108 GLOVER DR
Second Line	:
City	:	MOUNT ORAB
State	:	OH
Zip	:	45154-8390
Country	:	US
Telephone Number	:	937-444-2933
Fax Number	:	937-444-2924

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

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	06/09/2010

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Directions to “ REBECCA MAE WHITE DPT” Practice Location

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