Provider Demographics
NPI:1538650312
Name:ELLSWORTH-WHITE, RHONDA GAYLE (DPT)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:GAYLE
Last Name:ELLSWORTH-WHITE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 BUTTERFLY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7272
Mailing Address - Country:US
Mailing Address - Phone:757-418-2126
Mailing Address - Fax:
Practice Address - Street 1:312 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-5514
Practice Address - Country:US
Practice Address - Phone:757-421-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305004132OtherDEPARTMENT OF HEALTH PROFESSIONS