Provider Demographics
NPI:1093848400
Name:WHITE, HERBERT THOMAS
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:THOMAS
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 1:3875 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1105
Mailing Address - Country:US
Mailing Address - Phone:323-290-4363
Mailing Address - Fax:323-293-3327
Practice Address - Street 1:3875 S.WESTERN AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1105
Practice Address - Country:US
Practice Address - Phone:323-290-4363
Practice Address - Fax:323-293-3327
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner