Provider Demographics
NPI:1184621237
Name:WHITE, JOSHUA (MPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27118 MOUNTAIN PARK RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-5748
Mailing Address - Country:US
Mailing Address - Phone:303-325-5329
Mailing Address - Fax:303-670-3323
Practice Address - Street 1:3045 WHITMAN DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2210
Practice Address - Country:US
Practice Address - Phone:303-325-5329
Practice Address - Fax:303-670-3323
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7571OtherPHYSICAL THERAPY LICENSE
CO7571OtherPHYSICAL THERAPY LICENSE