Provider Demographics
NPI:1366141814
Name:WHITE, JOHNATHAN DEAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:DEAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 OSPREY CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-4101
Mailing Address - Country:US
Mailing Address - Phone:912-467-2226
Mailing Address - Fax:
Practice Address - Street 1:240 OSPREY CIR
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-4101
Practice Address - Country:US
Practice Address - Phone:912-467-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist