Provider Demographics
NPI:1982997805
Name:WHITE, BRETT (CP)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-1516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:715 FAIRGROVE CHURCH RD SE
Practice Address - Street 2:STE 203
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9290
Practice Address - Country:US
Practice Address - Phone:828-328-5347
Practice Address - Fax:828-328-4405
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C46948OtherBOC CERTIFICATION