Provider Demographics
NPI:1033363171
Name:WHITE, KATHLEEN (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
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 1:2229 KATHLEEN DR
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-5738
Mailing Address - Country:US
Mailing Address - Phone:607-748-6632
Mailing Address - Fax:
Practice Address - Street 1:G AND E THERAPIES
Practice Address - Street 2:1977 MARSHLAND ROAD
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732
Practice Address - Country:US
Practice Address - Phone:607-775-2874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011428-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist