Provider Demographics
NPI:1942305529
Name:WHITE, LOUISE J (PT)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4263 67TH AVENUE CIR E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-5192
Mailing Address - Country:US
Mailing Address - Phone:941-894-6090
Mailing Address - Fax:
Practice Address - Street 1:2820 MANATEE AVE W
Practice Address - Street 2:SUITE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4237
Practice Address - Country:US
Practice Address - Phone:941-749-1734
Practice Address - Fax:941-749-1736
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist