Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 11-05394 | KS |
Y | 225100000X | Physical Therapist | 2016024378 | MO |
N | 225100000X | Physical Therapist | PT 4261 | AR |
NPI | 1003265356 |
---|---|
Provider Name | Zachary Austin White |
First Address | Ooltewah, TN 37363-6511 |
Second Address | Webb City, MO 64870-2502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2016 |
Last Update Date | 09/02/2017 |