Provider Demographics
NPI:1982802369
Name:TURNER WHITE, TIA MARIE (LPTA)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:MARIE
Last Name:TURNER WHITE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-3022
Mailing Address - Country:US
Mailing Address - Phone:937-277-0053
Mailing Address - Fax:937-277-0053
Practice Address - Street 1:415 CHERRY DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-3022
Practice Address - Country:US
Practice Address - Phone:937-277-0053
Practice Address - Fax:937-277-0053
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA03221225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant