# OLYMPIC PHYSICAL MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255369963
- **Authorized official:** MR. DOUGLAS E WHITE MSPT, LATC, CSCS (PRESIDENT)
- **Authorized official phone:** (617) 666-8800

## Contact information

- **Practice address:** 200 MAIN STREET, 111, STONEHAM, MA 02180-1619
- **Practice address phone:** (617) 666-8800
- **Practice address fax:** (617) 666-4488
- **Mailing address:** 200 MAIN STREET, 111, STONEHAM, MA 02180-1619
- **Mailing address phone:** (617) 666-8800
- **Mailing address fax:** (617) 666-4488

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 2251S0007X | Sports Physical Therapist | — | NULL | Yes |
| 2251S0007X | Sports Physical Therapist | — | — | Yes |
| 2251X0800X | Orthopedic Physical Therapist | — | NULL | — |
| 2251X0800X | Orthopedic Physical Therapist | — | — | — |
| 2255A2300X | Athletic Trainer | — | NULL | — |
| 2255A2300X | Athletic Trainer | — | — | — |

## Other

- **Enumeration date:** 06/29/2006
- **Last updated:** 04/20/2008