Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2551 | NC |
NPI | 1003066457 |
---|---|
Provider Name | Shayne Marie White |
First Address | Taylorsville, NC 28681-3374 |
Second Address | Huntersville, NC 28078-5005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2008 |
Last Update Date | 21/01/2011 |