Provider Demographics
NPI:1306523493
Name:WHITE, VERDI RAY II (LMT)
Entity type:Individual
Prefix:MR
First Name:VERDI
Middle Name:RAY
Last Name:WHITE
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 S MELBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4044
Mailing Address - Country:US
Mailing Address - Phone:801-554-6290
Mailing Address - Fax:
Practice Address - Street 1:2906 S MELBOURNE ST
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84106-4044
Practice Address - Country:US
Practice Address - Phone:801-554-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5460784-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist