Provider Demographics
NPI:1457528002
Name:WHITE, ROBERT L JR (CMT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:WHITE
Suffix:JR
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 1:4444 B ST SE
Mailing Address - Street 2:#3
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4362
Mailing Address - Country:US
Mailing Address - Phone:301-675-0001
Mailing Address - Fax:
Practice Address - Street 1:4444 B ST SE
Practice Address - Street 2:#3
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4362
Practice Address - Country:US
Practice Address - Phone:301-675-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006781225700000X
DCMT1016225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist