Provider Demographics
NPI:1750602462
Name:WHITE, SPERANCIA ANNA (DPT)
Entity type:Individual
Prefix:
First Name:SPERANCIA
Middle Name:ANNA
Last Name:WHITE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SPERANCIA
Other - Middle Name:ANNA
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:519 SW NAGLE PL
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3157
Mailing Address - Country:US
Mailing Address - Phone:772-209-1183
Mailing Address - Fax:
Practice Address - Street 1:519 SW NAGLE PL
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3157
Practice Address - Country:US
Practice Address - Phone:772-209-1183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650366467OtherEMPLOYER IDENTIFICATION NUMBER (EIN)