Provider Demographics
NPI:1902452899
Name:WHITE, JUSTIN E (DPT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:E
Last Name:WHITE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 118TH AVE SE STE 110
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3875
Mailing Address - Country:US
Mailing Address - Phone:425-214-0020
Mailing Address - Fax:
Practice Address - Street 1:925 FRONTIER CIR E STE 100
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2423
Practice Address - Country:US
Practice Address - Phone:425-377-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist