Provider Demographics
NPI:1083026413
Name:WHITE, REBECCA LOUISE (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOUISE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CROSSFIELD DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1596
Mailing Address - Country:US
Mailing Address - Phone:859-879-0024
Mailing Address - Fax:
Practice Address - Street 1:260 CROSSFIELD DR
Practice Address - Street 2:UNIT 2
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1596
Practice Address - Country:US
Practice Address - Phone:859-879-0024
Practice Address - Fax:859-879-1102
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1025225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist