Provider Demographics
NPI:1073645313
Name:WHITE, JAMES BRIAN (DPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BRIAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32709
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2709
Mailing Address - Country:US
Mailing Address - Phone:865-558-6484
Mailing Address - Fax:865-584-4037
Practice Address - Street 1:490 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7550
Practice Address - Country:US
Practice Address - Phone:865-482-7730
Practice Address - Fax:865-481-0531
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3647417Medicaid
TN4148022OtherBCBST
3647417Medicare UPIN