Provider Demographics
NPI:1144280587
Name:WHITE, WILLIAM HARRISON (PT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HARRISON
Last Name:WHITE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 HALLS FARM RD
Mailing Address - Street 2:
Mailing Address - City:CAMINO
Mailing Address - State:CA
Mailing Address - Zip Code:95709
Mailing Address - Country:US
Mailing Address - Phone:530-644-4872
Mailing Address - Fax:
Practice Address - Street 1:1980 BROADWAY
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-9001
Practice Address - Country:US
Practice Address - Phone:530-622-3536
Practice Address - Fax:530-622-3538
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 3604225100000X
NMPT 3231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist