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General NPI Number Information
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NPI Number | 1457815466
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Entity Type | Individual
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Provider Name | JOHANNA LEIGH WHITE MA, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 12420 BAILEY RD
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City | CORNELIUS
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State | NC
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Zip | 28031-9134
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Country | US
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Telephone | 980-344-0514
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 SOUTH BLVD APT 566
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City | CHARLOTTE
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State | NC
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Zip | 28203-6534
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Country | US
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Telephone | 910-233-2547
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | LAT-2925
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License Number State | NC
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