Healthcare Provider Details

I. General information

NPI: 1154447647
Provider Name (Legal Business Name): VALERIE MARIE WHITE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 GREENBANK RD
WILMINGTON DE
19808-3164
US

IV. Provider business mailing address

1251 RIVERSIDE DR
WILMINGTON DE
19809-2434
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-0101
  • Fax:
Mailing address:
  • Phone: 302-547-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000301
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: