Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
Y | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1184655458 |
---|---|
Provider Name | Mr. Douglas E White |
First Address | Andover, MA 01810-0811 |
Second Address | Andover, MA 01810-5638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 22/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0308943 | (05) | MA |
467531 | TUFTS (01) | MA |
Y67383 | BC/BS (01) | MA |