Basic Information
| Provider Information | |||||||||
| NPI: | 1790979565 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHYTE | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | DAVIDSON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 POST RD | ||||||||
| Address2: | # 3A | ||||||||
| City: | DARIEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068204622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032022703 | ||||||||
| FaxNumber: | 2036213162 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | COS COB | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068072717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034220679 | ||||||||
| FaxNumber: | 2034220931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2007 | ||||||||
| LastUpdateDate: | 06/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 007753 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | P00903273 | 01 | CT | MEDICARE RAILROAD | OTHER |