Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 7780 | TN |
NPI | 1073645313 |
---|---|
Provider Name | Mr. James Brian White |
First Address | Knoxville, TN 37930-2709 |
Second Address | Oak Ridge, TN 37830-7550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 05/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3647417 | (02) | |
3647417 | (05) | TN |
4148022 | BCBST (01) | TN |