Healthcare Provider Details

I. General information

NPI: 1679677181
Provider Name (Legal Business Name): MELISSA LEE WHITE MS,PT,PCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 OSLO CIR
BIRMINGHAM AL
35211-5965
US

IV. Provider business mailing address

322 OAK TRCE
HOOVER AL
35244-4517
US

V. Phone/Fax

Practice location:
  • Phone: 205-944-3939
  • Fax: 205-944-3991
Mailing address:
  • Phone: 206-682-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTH2267
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: