Provider Demographics
NPI:1689790313
Name:WHITE, JENNIFER CELESTE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CELESTE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1808
Mailing Address - Country:US
Mailing Address - Phone:315-475-9624
Mailing Address - Fax:315-701-0450
Practice Address - Street 1:1001 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1808
Practice Address - Country:US
Practice Address - Phone:315-475-9624
Practice Address - Fax:315-701-0450
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126421225100000X
NY0170151225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010012642OtherBC BS INSURANCE OF CNY
NY714708OtherMVP INSURANCE
0160254OtherBC BS INSURANCE OF CNY
NY714708OtherMVP INSURANCE
0160254OtherBC BS INSURANCE OF CNY