Provider Demographics
NPI:1568746055
Name:WHITE, MIRIAM LEE (LMT, MMP)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:AMISSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20106-0487
Mailing Address - Country:US
Mailing Address - Phone:540-937-3595
Mailing Address - Fax:
Practice Address - Street 1:20 S 2ND ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3338
Practice Address - Country:US
Practice Address - Phone:540-347-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist