Provider Demographics
NPI:1194722736
Name:WHITE, BENTE R (PT)
Entity type:Individual
Prefix:MS
First Name:BENTE
Middle Name:R
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WIMBLEDON SQ
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4931
Mailing Address - Country:US
Mailing Address - Phone:757-547-5145
Mailing Address - Fax:757-436-2480
Practice Address - Street 1:100 WIMBLEDON SQ
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4931
Practice Address - Country:US
Practice Address - Phone:757-547-5145
Practice Address - Fax:757-436-2480
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052040022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA139941OtherANTHEM BC/BS