Provider Demographics
NPI:1659519809
Name:WHITE, JEAN CLAIRE (PTA)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:CLAIRE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:JEANNIE
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 17860
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92177-7860
Mailing Address - Country:US
Mailing Address - Phone:800-787-6787
Mailing Address - Fax:800-787-6762
Practice Address - Street 1:4655 RUFFNER STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2275
Practice Address - Country:US
Practice Address - Phone:800-787-6787
Practice Address - Fax:800-787-6762
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT2573225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant