Provider Demographics
NPI:1144361130
Name:WHITE, JOHN MARK (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:WHITE
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 NW 120TH CT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-1729
Mailing Address - Country:US
Mailing Address - Phone:405-773-0442
Mailing Address - Fax:405-773-0446
Practice Address - Street 1:6006 NW 120TH CT
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-1729
Practice Address - Country:US
Practice Address - Phone:405-773-0442
Practice Address - Fax:405-773-0446
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP50117Medicare UPIN