Provider Demographics
NPI:1538478847
Name:WHITE, ROXANN MARIE (MSPT)
Entity Type:Individual
Prefix:
First Name:ROXANN
Middle Name:MARIE
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 1:813 LOWER MILL BAY RD
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-7314
Mailing Address - Country:US
Mailing Address - Phone:907-486-1793
Mailing Address - Fax:
Practice Address - Street 1:813 LOWER MILL BAY RD
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-7314
Practice Address - Country:US
Practice Address - Phone:907-486-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist