Provider Demographics
NPI:1801491808
Name:WHITE, VICTORIA PAIGE (DPT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:PAIGE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24035 KADENCE LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-8900
Mailing Address - Country:US
Mailing Address - Phone:205-712-8295
Mailing Address - Fax:
Practice Address - Street 1:22454 US HIGHWAY 72 # 210
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-2609
Practice Address - Country:US
Practice Address - Phone:256-233-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH10115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist