Provider Demographics
NPI:1114248788
Name:WHITE, PRECIOUS R (LPTA)
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:R
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 1:703 FALLS ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-2839
Mailing Address - Country:US
Mailing Address - Phone:434-607-9670
Mailing Address - Fax:
Practice Address - Street 1:703 FALLS ST.
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:VA
Practice Address - Zip Code:23824
Practice Address - Country:US
Practice Address - Phone:434-607-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602283225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant