Provider Demographics
NPI:1275813735
Name:WHITE, MICHELLE L (PTA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 PUMPKINVINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-7402
Mailing Address - Country:US
Mailing Address - Phone:795-349-6248
Mailing Address - Fax:
Practice Address - Street 1:1835 PUMPKINVINE HILL RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-7402
Practice Address - Country:US
Practice Address - Phone:795-349-6248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002885A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant