Provider Demographics
NPI:1083821862
Name:WHITE, ASHLEY (PT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25910 CANAL RD
Mailing Address - Street 2:STE P
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-5016
Mailing Address - Country:US
Mailing Address - Phone:251-981-7778
Mailing Address - Fax:251-981-7773
Practice Address - Street 1:25910 CANAL RD
Practice Address - Street 2:STE P
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-5016
Practice Address - Country:US
Practice Address - Phone:251-981-7778
Practice Address - Fax:251-981-7773
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL21311OtherSTATE LICENSE