Provider Demographics
NPI:1073859674
Name:WHITE, JENNY J (LMT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FIELDSTONE XING
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHINA
Mailing Address - State:ME
Mailing Address - Zip Code:04358-5200
Mailing Address - Country:US
Mailing Address - Phone:207-689-8003
Mailing Address - Fax:
Practice Address - Street 1:24 FIELDSTONE XING
Practice Address - Street 2:
Practice Address - City:SOUTH CHINA
Practice Address - State:ME
Practice Address - Zip Code:04358-5200
Practice Address - Country:US
Practice Address - Phone:207-689-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5006172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist