MEDICARE: CONNY EVELYN 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	4239	AZ

General Provider Information

NPI Number	:	1811989775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNY EVELYN WHITE PT

Provider Business Mailing Address
First Line	:	10550 N LA CANADA DR STE 160
Second Line	:
City	:	ORO VALLEY
State	:	AZ
Zip	:	85737-7047
Country	:	US
Telephone Number	:	520-547-2476
Fax Number	:	520-293-6638

Provider Business Practice Location Address
First Line	:	10550 N LA CANADA DR STE 160
Second Line	:
City	:	ORO VALLEY
State	:	AZ
Zip	:	85737
Country	:	US
Telephone Number	:	520-547-2476
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	06/21/2018

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