Healthcare Provider Details

I. General information

NPI: 1598947574
Provider Name (Legal Business Name): KAREN W WHITE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14339 MEADOW RIDGE WAY DR.
BATON ROUGE LA
70817
US

IV. Provider business mailing address

14339 MEADOW RIDGE WAY DRIVE
BATON ROUGE LA
70817
US

V. Phone/Fax

Practice location:
  • Phone: 225-753-8581
  • Fax:
Mailing address:
  • Phone: 225-753-8581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: