Provider Demographics
NPI:1184655458
Name:WHITE, DOUGLAS E (MSPT, L/ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:E
Last Name:WHITE
Suffix:
Gender:M
Credentials:MSPT, L/ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4053
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-0811
Mailing Address - Country:US
Mailing Address - Phone:978-658-5556
Mailing Address - Fax:978-658-5269
Practice Address - Street 1:187 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-5638
Practice Address - Country:US
Practice Address - Phone:978-658-5556
Practice Address - Fax:978-658-5269
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67383OtherBC/BS
MA0308943Medicaid
MA467531OtherTUFTS
MAWHY68914Medicare ID - Type Unspecified