Provider Demographics
NPI:1215562483
Name:WHITE, BOBBY JOE III (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:JOE
Last Name:WHITE
Suffix:III
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5147 37TH ST
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-5907
Mailing Address - Country:US
Mailing Address - Phone:832-279-7374
Mailing Address - Fax:
Practice Address - Street 1:2711 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-6952
Practice Address - Country:US
Practice Address - Phone:432-279-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13283422251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic