Individual
KEVIN THOMAS WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
169 LYNCH CREEK WAY, PETALUMA, CA 94954-2344
(707) 763-0115
(707) 763-2130
Mailing address
2 HILLIGOSS CT, PETALUMA, CA 94952-5742
(707) 766-8109
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT18789
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT18789
LICENSE
CA
Enumeration date
10/17/2006
Last updated
07/08/2007
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