Provider Demographics
NPI:1710096508
Name:WHITE, JENNIFER ELAINE (MSPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELAINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ELAINE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8600 BELLA VISTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1869
Mailing Address - Country:US
Mailing Address - Phone:854-829-8881
Mailing Address - Fax:954-943-2747
Practice Address - Street 1:8600 BELLA VISTA DRIVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-1869
Practice Address - Country:US
Practice Address - Phone:854-829-8881
Practice Address - Fax:954-943-2747
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2971ZMedicare ID - Type UnspecifiedMEDICARE NUMBER