Provider Demographics
NPI:1003097064
Name:WHITE, DONNA (PT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 7TH AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3689
Mailing Address - Country:US
Mailing Address - Phone:718-369-8000
Mailing Address - Fax:718-369-8039
Practice Address - Street 1:1309 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3605
Practice Address - Country:US
Practice Address - Phone:718-677-7680
Practice Address - Fax:718-677-6586
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4575Q4AC1Medicare PIN