Provider Demographics
NPI:1073043774
Name:WHITE, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7542 COUNTY ROAD 17
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:NY
Mailing Address - Zip Code:14711-8628
Mailing Address - Country:US
Mailing Address - Phone:585-738-6922
Mailing Address - Fax:
Practice Address - Street 1:312 MILLBURY AVE
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-3622
Practice Address - Country:US
Practice Address - Phone:508-793-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010886225200000X
WAP160839363225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant