Provider Demographics
NPI:1417483280
Name:WHITE, ALEX (PT, DPT, OCS, CSCS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:PT, DPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 9TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8203
Mailing Address - Country:US
Mailing Address - Phone:406-670-5412
Mailing Address - Fax:
Practice Address - Street 1:243 CHENEY DR W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4277
Practice Address - Country:US
Practice Address - Phone:208-329-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist