Provider Demographics
NPI:1306102900
Name:WHITE, DAVID S (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:S
Last Name:WHITE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2 DAVIS POINT LN
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2620
Mailing Address - Country:US
Mailing Address - Phone:207-767-9773
Mailing Address - Fax:207-541-9212
Practice Address - Street 1:2 DAVIS POINT LN
Practice Address - Street 2:SUITE 1A
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-2620
Practice Address - Country:US
Practice Address - Phone:207-767-9773
Practice Address - Fax:207-541-9212
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT7792251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics