Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 1278 | TX |
N | 225100000X | Physical Therapist | 1144657 | TX |
N | 2251G0304X | Physical Therapist - Geriatrics | 1144657 | |
N | 2251X0800X | Physical Therapist - Orthopedic | 1144657 |
NPI | 1104237189 |
---|---|
Provider Name | Mr. Brent Richard White |
First Address | Webster, TX 77598 |
Second Address | Webster, TX 77598 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 13/05/2014 |