Provider Demographics
NPI:1033379763
Name:WHITE, DIANNE MCBRIDE (MPT)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:MCBRIDE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 NE STANTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3118
Mailing Address - Country:US
Mailing Address - Phone:314-226-3322
Mailing Address - Fax:
Practice Address - Street 1:637 NE STANTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3118
Practice Address - Country:US
Practice Address - Phone:314-226-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist