Provider Demographics
NPI:1083837397
Name:WHITE, WILLIAM R (PT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:WHITE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:R
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:16119 CARLOW CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-6107
Mailing Address - Country:US
Mailing Address - Phone:815-478-0060
Mailing Address - Fax:
Practice Address - Street 1:10309 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1280
Practice Address - Country:US
Practice Address - Phone:815-469-9515
Practice Address - Fax:815-469-9570
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-011926225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic