Provider Demographics
NPI:1790713485
Name:WHITE'S PHYSICAL THERAPY & BODYMECHANIX, LLC
Entity Type:Organization
Organization Name:WHITE'S PHYSICAL THERAPY & BODYMECHANIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, L/ATC, CSCS
Authorized Official - Phone:978-568-5556
Mailing Address - Street 1:PO BOX 4053
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-0811
Mailing Address - Country:US
Mailing Address - Phone:978-658-5556
Mailing Address - Fax:978-658-5269
Practice Address - Street 1:1 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-3926
Practice Address - Country:US
Practice Address - Phone:978-658-5556
Practice Address - Fax:978-658-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA619996OtherTUFTS
MAY61369OtherBC/BS
MA0308943Medicaid
MAWHY68914Medicare ID - Type Unspecified