MEDICARE: BENJAMIN A 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	22202	MA
2	225100000X	Physical Therapist	292009	CA
3	225100000X	Physical Therapist	PT017332	OH

General Provider Information

NPI Number	:	1407215528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN A WHITE PT, DPT

Provider Business Mailing Address
First Line	:	2516 FAIRWOOD CT
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-1765
Country	:	US
Telephone Number	:	812-361-6212
Fax Number	:

Provider Business Practice Location Address
First Line	:	2516 FAIRWOOD CT
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-1765
Country	:	US
Telephone Number	:	812-361-6212
Fax Number	:

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

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	04/30/2018

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