MEDICARE: MARTHA 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	225100000X	Physical Therapist	5120	FL

General Provider Information

NPI Number	:	1588675862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA WHITE

Provider Business Mailing Address
First Line	:	PO BOX 39
Second Line	:
City	:	TERRA CEIA
State	:	FL
Zip	:	34250-0039
Country	:	US
Telephone Number	:	941-758-2111
Fax Number	:	941-758-2082

Provider Business Practice Location Address
First Line	:	4426 5TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-1531
Country	:	US
Telephone Number	:	941-758-2111
Fax Number	:	941-758-2082

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	12/31/2007

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Directions to “ MARTHA WHITE ” Practice Location

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