Provider Demographics
NPI:1942594494
Name:WHITE, DAVID RYAN (CMT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RYAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5498 E BRIARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2318
Mailing Address - Country:US
Mailing Address - Phone:720-394-9927
Mailing Address - Fax:888-267-9159
Practice Address - Street 1:340 3RD ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2438
Practice Address - Country:US
Practice Address - Phone:720-394-9927
Practice Address - Fax:888-267-9159
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-10937225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist