Provider Demographics
NPI:1992807671
Name:WHITE, DAMON (MS, ATC, NASM-PES)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:MS, ATC, NASM-PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COLD SPRING RD APT D505
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3149
Mailing Address - Country:US
Mailing Address - Phone:860-529-3439
Mailing Address - Fax:
Practice Address - Street 1:57 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3606
Practice Address - Country:US
Practice Address - Phone:860-343-5997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer