Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT779 | ME |
NPI | 1306102900 |
---|---|
Provider Name | Mr. David S. White |
First Address | Cape Elizabeth, ME 04107-2620 |
Second Address | Cape Elizabeth, ME 04107-2620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 09/04/2012 |