Provider Demographics
NPI:1497779367
Name:WHITE, BARRY LANE (PT)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:LANE
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 1:636 LIPFORD DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-7072
Mailing Address - Country:US
Mailing Address - Phone:919-377-8804
Mailing Address - Fax:
Practice Address - Street 1:1001 SHELDON DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2078
Practice Address - Country:US
Practice Address - Phone:919-345-9196
Practice Address - Fax:919-277-9942
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP7569225100000X
ALPTH1284225100000X, 2251E1300X
GAPT000594225100000X
GA5942251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBBJTMedicare PIN
AL00033673Medicare PIN