Provider Demographics
NPI:1578566428
Name:WHITE, DOUGLAS M (DPT)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:WHITE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54-396 UNION MILL RD UNIT 1179
Mailing Address - Street 2:
Mailing Address - City:KAPAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96755-3050
Mailing Address - Country:US
Mailing Address - Phone:808-796-3221
Mailing Address - Fax:
Practice Address - Street 1:55-3435 AKONI PULE HWY
Practice Address - Street 2:#7
Practice Address - City:HAWI
Practice Address - State:HI
Practice Address - Zip Code:96719
Practice Address - Country:US
Practice Address - Phone:617-696-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56592251X0800X
HIPT-50252251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA66302Medicare ID - Type Unspecified