Provider Demographics
NPI:1285954420
Name:WHITE, MICHAEL R (DPT)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:WHITE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8838 US 70 BUS HWY W STE 300
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4822
Mailing Address - Country:US
Mailing Address - Phone:919-550-7722
Mailing Address - Fax:
Practice Address - Street 1:8838 US 70 BUS HWY W STE 300
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-4822
Practice Address - Country:US
Practice Address - Phone:919-550-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist