Provider Demographics
NPI:1003265356
Name:WHITE, ZACHARY AUSTIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:AUSTIN
Last Name:WHITE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:501 S MADISON ST
Practice Address - Street 2:STE L
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-2502
Practice Address - Country:US
Practice Address - Phone:417-673-2156
Practice Address - Fax:417-673-2176
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05394225100000X
MO2016024378225100000X
ARPT 4261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist