Provider Demographics
NPI:1396515078
Name:WHITE, BRIAN (ATC/L, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:ATC/L, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 W NEAL ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75428-4311
Mailing Address - Country:US
Mailing Address - Phone:650-823-4929
Mailing Address - Fax:
Practice Address - Street 1:2600 W NEAL ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428-4311
Practice Address - Country:US
Practice Address - Phone:650-823-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT9514207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine