Provider Demographics
NPI:1740758192
Name:WHITE, ANNETTE ALENE (PTA)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:ALENE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3258 UNION CAMP RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-3766
Mailing Address - Country:US
Mailing Address - Phone:615-666-5871
Mailing Address - Fax:
Practice Address - Street 1:3258 UNION CAMP RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-3766
Practice Address - Country:US
Practice Address - Phone:615-666-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-04
Last Update Date:2018-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2737225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant