Provider Demographics
NPI:1851688709
Name:WHITE, JESSICA LYNNE (DPT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYNNE
Last Name: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 1:22502 SAMBAR LOOP
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5377
Mailing Address - Country:US
Mailing Address - Phone:503-757-3488
Mailing Address - Fax:
Practice Address - Street 1:22502 SAMBAR LOOP
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5377
Practice Address - Country:US
Practice Address - Phone:503-757-3488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPHYP2511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1477886232OtherNPI