Deidre Deacon White, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT293126 Issued in CA

Practice address

1285 Florida St
Imperial Beach, CA 91932-3505

Phone

(540) 294-3625

NPI assigned

Sep 27, 2016

Last updated

Mar 24, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Deidre Deacon Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585008000000",
    "number": "1184173486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1285 FLORIDA ST",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "919323505",
            "telephone_number": "540-294-3625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1285 FLORIDA ST",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "919323505",
            "telephone_number": "540-294-3625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "DEIDRE",
        "middle_name": "DEACON",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-27",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT293126",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305210672",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Deidre.whitept@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "1285 Florida St",
            "city": "Imperial Beach",
            "state": "CA",
            "country_code": "US",
            "postal_code": "919323505",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Deidre.whitept@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "1285 Florida St",
            "city": "Imperial Beach",
            "state": "CA",
            "country_code": "US",
            "postal_code": "919323505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DEIDRE",
            "last_name": "DEACON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Imperial Beach, CA
• Providers in Imperial Beach, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.