Healthcare Provider Details

I. General information

NPI: 1811194657
Provider Name (Legal Business Name): DEENA LOUISE WHITE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEENA LOUISE FOGARTY PT

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 PARKSIDE DR SUITE 209
KNOXVILLE TN
37934-1979
US

IV. Provider business mailing address

10810 PARKSIDE DR SUITE 209
KNOXVILLE TN
37934-1979
US

V. Phone/Fax

Practice location:
  • Phone: 865-251-3030
  • Fax: 865-966-0191
Mailing address:
  • Phone: 865-251-3030
  • Fax: 865-966-0191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4034
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: