Provider Demographics
NPI:1730443342
Name:WHITE, TERRY DEWAYNE JR (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:DEWAYNE
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:TJ
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:100 DISCOVERY BAY LN
Mailing Address - Street 2:#22
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-2401
Mailing Address - Country:US
Mailing Address - Phone:501-860-8700
Mailing Address - Fax:
Practice Address - Street 1:300 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-4003
Practice Address - Country:US
Practice Address - Phone:501-622-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 5012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer