Provider Demographics
NPI:1134127582
Name:WHITE, JOSHUA WILLIAM (MPT)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:WILLIAM
Last Name:WHITE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 GLAMORGAN ST
Mailing Address - Street 2:STE. 110
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-2938
Mailing Address - Country:US
Mailing Address - Phone:330-821-2249
Mailing Address - Fax:330-821-9318
Practice Address - Street 1:75 GLAMORGAN ST
Practice Address - Street 2:STE. 110
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2938
Practice Address - Country:US
Practice Address - Phone:330-821-2249
Practice Address - Fax:330-821-9318
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-009178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH650021146OtherR/R MEDICARE PROV #
OH2336109Medicaid
OH2336109Medicaid
OHWH4029071Medicare ID - Type Unspecified