Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 070-011926 | IL |
N | 2251X0800X | Physical Therapist - Orthopedic | 070-011926 | IL |
NPI | 1083837397 |
---|---|
Provider Name | Mr. William R White |
First Address | Manhattan, IL 60442-6107 |
Second Address | Frankfort, IL 60423-1280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 08/07/2007 |