Provider Demographics
NPI:1659404689
Name:WHITE, TIMOTHY GARY JR (PTA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GARY
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03598-3094
Mailing Address - Country:US
Mailing Address - Phone:603-837-2802
Mailing Address - Fax:
Practice Address - Street 1:93 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANCONIA
Practice Address - State:NH
Practice Address - Zip Code:03580-4801
Practice Address - Country:US
Practice Address - Phone:603-823-5502
Practice Address - Fax:603-823-7138
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH559225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant