Individual
MR. ETHAN WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH2033
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
418961932
TRICARE
AL
01
—
51094044
BLUE CROSS
AL
01
—
6400002
UNITED HEALTH CARE
AL
Enumeration date
10/02/2006
Last updated
08/28/2013
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