MEDICARE: CATHERINE A WHITE PT

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	070020953	IL

General Provider Information

NPI Number	:	1750771036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE A WHITE PT

Provider Business Mailing Address
First Line	:	3057 N PERRYVILLE RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-8016
Country	:	US
Telephone Number	:	815-637-1100
Fax Number	:	815-637-1200

Provider Business Practice Location Address
First Line	:	3057 N PERRYVILLE RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-8016
Country	:	US
Telephone Number	:	815-637-1100
Fax Number	:	815-637-1200

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

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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