Provider Demographics
NPI:1881842748
Name:WHITE, JOYCE S (PT)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:S
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:A
Other - Last Name:RUDZIANSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:RR6 BOX 189
Mailing Address - Street 2:SR 3001
Mailing Address - City:MONTROSE
Mailing Address - State:PA
Mailing Address - Zip Code:18801
Mailing Address - Country:US
Mailing Address - Phone:570-278-2482
Mailing Address - Fax:
Practice Address - Street 1:RR 4 BOX 189
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-8915
Practice Address - Country:US
Practice Address - Phone:570-278-2482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PAPT001424E225100000X, 2251S0007X, 2251X0800X
SC222225100000X
MA7066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30-0499644OtherEIN