Provider Demographics
NPI:1740565423
Name:WHITE, JODY B (MS, PT)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:B
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 AVENIDA ENCINAS STE 125
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4689
Mailing Address - Country:US
Mailing Address - Phone:760-603-9457
Mailing Address - Fax:760-603-9759
Practice Address - Street 1:7220 AVENIDA ENCINAS
Practice Address - Street 2:SUITE 125
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4690
Practice Address - Country:US
Practice Address - Phone:760-603-9457
Practice Address - Fax:760-603-9759
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10253033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist