Provider Demographics
NPI:1417039793
Name:WHITE, AMIE KAYE DERRICK (DPT)
Entity Type:Individual
Prefix:DR
First Name:AMIE KAYE
Middle Name:DERRICK
Last Name:WHITE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:114 KEOWEE SCHOOL RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-6779
Mailing Address - Country:US
Mailing Address - Phone:864-539-2204
Mailing Address - Fax:855-344-5560
Practice Address - Street 1:114 KEOWEE SCHOOL RD UNIT C
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-6779
Practice Address - Country:US
Practice Address - Phone:864-539-2204
Practice Address - Fax:855-344-5560
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4873225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic