Provider Demographics
NPI:1598312142
Name:WHITE, BRENDAN (PT,DPT)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:WHITE
Suffix:
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 1:577 52ND AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-2845
Mailing Address - Country:US
Mailing Address - Phone:850-582-2025
Mailing Address - Fax:
Practice Address - Street 1:4852 PARK ST N STE 5
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2226
Practice Address - Country:US
Practice Address - Phone:727-440-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist