Provider Demographics
NPI:1811194657
Name:WHITE, DEENA LOUISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEENA
Middle Name:LOUISE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DEENA
Other - Middle Name:LOUISE
Other - Last Name:FOGARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10810 PARKSIDE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1979
Mailing Address - Country:US
Mailing Address - Phone:865-251-3030
Mailing Address - Fax:865-966-0191
Practice Address - Street 1:10810 PARKSIDE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1979
Practice Address - Country:US
Practice Address - Phone:865-251-3030
Practice Address - Fax:865-966-0191
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I653936Medicare PIN