MEDICARE: COURTNEY E WHITE D.P.T.

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	4716	OK

General Provider Information

NPI Number	:	1700297611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY E WHITE D.P.T.

Provider Business Mailing Address
First Line	:	5419 S 79TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-7834
Country	:	US
Telephone Number	:	918-519-1713
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 S DENVER AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74119-3423
Country	:	US
Telephone Number	:	918-712-7805
Fax Number	:

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

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	05/13/2014

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Directions to “ COURTNEY E WHITE D.P.T.” Practice Location

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