Provider Demographics
NPI:1518092840
Name:WHITE, RHONDA C (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:C
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15323 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-3103
Mailing Address - Country:US
Mailing Address - Phone:708-849-2740
Mailing Address - Fax:708-849-3404
Practice Address - Street 1:15323 HASTINGS DR
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-3103
Practice Address - Country:US
Practice Address - Phone:708-849-2740
Practice Address - Fax:708-849-3404
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist