Provider Demographics
NPI:1063645372
Name:WHITE, DORI M (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DORI
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:DORI
Other - Middle Name:M
Other - Last Name:RODRIGUEZ WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:9955 SE WASHINGTON ST
Mailing Address - Street 2:SUITE #320
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2439
Mailing Address - Country:US
Mailing Address - Phone:503-957-3696
Mailing Address - Fax:503-253-0377
Practice Address - Street 1:9955 SE WASHINGTON ST
Practice Address - Street 2:SUITE #320
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2439
Practice Address - Country:US
Practice Address - Phone:503-957-3696
Practice Address - Fax:503-253-0377
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6904172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist