Provider Demographics
NPI:1962084590
Name:WHITE, CRAIG ANTHONY (PT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:ANTHONY
Last Name:WHITE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6049 BAGDAD DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-1348
Mailing Address - Country:US
Mailing Address - Phone:513-520-7142
Mailing Address - Fax:
Practice Address - Street 1:3550 SHAW AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1416
Practice Address - Country:US
Practice Address - Phone:513-533-5053
Practice Address - Fax:513-533-5054
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0098542251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics