Provider Demographics
NPI:1043363369
Name:WHITE, SANDY ELIZABETH (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:ELIZABETH
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8592 PINE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-9717
Mailing Address - Country:US
Mailing Address - Phone:601-737-2301
Mailing Address - Fax:601-663-1297
Practice Address - Street 1:1001 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2161
Practice Address - Country:US
Practice Address - Phone:601-663-1296
Practice Address - Fax:601-663-1297
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3295225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant