Provider Demographics
NPI:1932194412
Name:WHITE, ERIN MICHELLE (PT)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:MICHELLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 E MOSELEY RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-1155
Mailing Address - Country:US
Mailing Address - Phone:847-868-6383
Mailing Address - Fax:847-348-2158
Practice Address - Street 1:777 LAKE ZURICH RD
Practice Address - Street 2:SUITE 125B
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3106
Practice Address - Country:US
Practice Address - Phone:847-466-1025
Practice Address - Fax:847-466-1101
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.021239172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8857630Medicare UPIN