Provider Demographics
NPI:1790003382
Name:WHITE, HEATHER MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:TIPSORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:169 N 200 E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-8895
Mailing Address - Country:US
Mailing Address - Phone:260-244-5133
Mailing Address - Fax:260-244-5134
Practice Address - Street 1:169 N 200 E
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-8895
Practice Address - Country:US
Practice Address - Phone:260-244-5133
Practice Address - Fax:260-244-5134
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012304A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist