Provider Demographics
NPI:1083722268
Name:WHITE, SEAN THOMAS (PT, DPT, OCS, CMDT)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:THOMAS
Last Name:WHITE
Suffix:
Gender:M
Credentials:PT, DPT, OCS, CMDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 N 200 E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-8895
Mailing Address - Country:US
Mailing Address - Phone:260-244-5133
Mailing Address - Fax:260-244-5134
Practice Address - Street 1:169 N 200 E
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-8895
Practice Address - Country:US
Practice Address - Phone:260-244-5133
Practice Address - Fax:260-255-5134
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007643A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000382035OtherANTHEM BLUE CROSS
IN232920BMedicare ID - Type Unspecified