Provider Demographics
NPI:1508136524
Name:WHITE, ROXANNE LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CLOVERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-6527
Mailing Address - Country:US
Mailing Address - Phone:480-540-2149
Mailing Address - Fax:
Practice Address - Street 1:250 CLOVERVIEW CT
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-6527
Practice Address - Country:US
Practice Address - Phone:480-540-2149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7788225100000X
TX1211677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist