Provider Demographics
NPI:1770787947
Name:WHITE, DAVID RYAN (LMP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RYAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-330-0633
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:11700 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE 503
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5432
Practice Address - Country:US
Practice Address - Phone:425-349-9692
Practice Address - Fax:425-349-9694
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022359225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8944930OtherL&I CRIME VICTIMS
WA8794WHOtherREGENCE BS
WA2358WHOtherREGENCE BS
WA3253WHOtherREGENCE BS
WA9257059OtherAETNA/WHOLE HEALTH
WA0222411OtherDEPT OF L&I