1619416559 NPI number — MR. HENRY DULIN WHITE II PT, PHD

Table of content: MR. HENRY DULIN WHITE II PT, PHD (NPI 1619416559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619416559 NPI number — MR. HENRY DULIN WHITE II PT, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
HENRY
Provider Middle Name:
DULIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
PT, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITE
Provider Other First Name:
HANK
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619416559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 CONN TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40508-3206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-268-5771
Provider Business Mailing Address Fax Number:
859-268-5779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 CONN TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40508-3206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-268-5771
Provider Business Practice Location Address Fax Number:
859-268-5779
Provider Enumeration Date:
02/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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