Provider Demographics
NPI:1003958265
Name:WHITE, ANTHONY (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
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 1:2220 SAINT CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-4942
Mailing Address - Country:US
Mailing Address - Phone:727-269-1082
Mailing Address - Fax:
Practice Address - Street 1:2220 SAINT CHARLES DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-4942
Practice Address - Country:US
Practice Address - Phone:727-269-1082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207412251G0304X
FL23720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23720OtherFLORIDA STATE PT LICENSE
MD616514OtherBC BS