=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487239190
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTY DAWN WHITE PT, DPT, NCS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2021
-----------------------------------------------------
Last Update Date | 03/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3920 DUTCHMANS LN
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-4702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-259-6608
-----------------------------------------------------
Fax | 502-259-6605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3920 DUTCHMANS LN
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-4702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-259-6608
-----------------------------------------------------
Fax | 502-259-6605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physical Therapist
-----------------------------------------------------
License Number | 006377
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------