Healthcare Provider Details

I. General information

NPI: 1740969658
Provider Name (Legal Business Name): SYDNEY NICOLE WHITE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8097 HAMILTON AVE
CINCINNATI OH
45231-2321
US

IV. Provider business mailing address

6257 CHABLIS DR
LIBERTY TWP OH
45011-5258
US

V. Phone/Fax

Practice location:
  • Phone: 513-931-5000
  • Fax:
Mailing address:
  • Phone: 513-240-2073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: