Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 23720 | FL |
Y | 2251G0304X | Physical Therapist - Geriatrics | 20741 | MD |
NPI | 1003958265 |
---|---|
Provider Name | Mr. Anthony White |
First Address | Clearwater, FL 33764-4942 |
Second Address | Clearwater, FL 33764-4942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 05/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23720 | FLORIDA STATE PT LICENSE (01) | FL |
616514 | BC BS (01) | MD |