Provider Demographics
NPI:1336348762
Name:WHITE, ALICIA FAYE (DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:FAYE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6277 LOVE WARNER RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9621
Mailing Address - Country:US
Mailing Address - Phone:330-360-3826
Mailing Address - Fax:
Practice Address - Street 1:6277 LOVE WARNER RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9621
Practice Address - Country:US
Practice Address - Phone:330-360-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist