Provider Demographics
NPI:1366541773
Name:WHITE, BRUCE DM (MSPT)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:DM
Last Name:WHITE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 CORPORATE WAY STE A11
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2048
Mailing Address - Country:US
Mailing Address - Phone:561-432-0111
Mailing Address - Fax:561-432-1075
Practice Address - Street 1:11440 OKEECHOBEE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8707
Practice Address - Country:US
Practice Address - Phone:561-792-9859
Practice Address - Fax:561-792-8521
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL822053OtherACN GROUP
FL11366904OtherCAQH
FL891435400Medicaid