Provider Demographics
NPI:1962837872
Name:WHITE, STEPHANNIE S (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANNIE
Middle Name:S
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 1:310 E TENNYSON AVE
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-4626
Mailing Address - Country:US
Mailing Address - Phone:405-742-8430
Mailing Address - Fax:405-598-2054
Practice Address - Street 1:503 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-2017
Practice Address - Country:US
Practice Address - Phone:405-598-2899
Practice Address - Fax:405-598-2833
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKPT2603OtherPT LICENSE