Provider Demographics
NPI:1780652941
Name:WHITE SANDS PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:WHITE SANDS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS
Authorized Official - Phone:850-301-1935
Mailing Address - Street 1:600 OPP DRIVE
Mailing Address - Street 2:
Mailing Address - City:FT. WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4493
Mailing Address - Country:US
Mailing Address - Phone:850-301-1935
Mailing Address - Fax:850-301-1937
Practice Address - Street 1:600 OPP DRIVE
Practice Address - Street 2:
Practice Address - City:FT. WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4493
Practice Address - Country:US
Practice Address - Phone:850-301-1935
Practice Address - Fax:850-301-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL250750708034261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8564Medicare UPIN