Provider Demographics
NPI:1053943472
Name:FRENCH, MAFALDA WHITE
Entity type:Individual
Prefix:
First Name:MAFALDA
Middle Name:WHITE
Last Name:FRENCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 S RIPLEY RD
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-8893
Mailing Address - Country:US
Mailing Address - Phone:606-882-2718
Mailing Address - Fax:
Practice Address - Street 1:19189 STATE ROUTE 136
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45697-9800
Practice Address - Country:US
Practice Address - Phone:937-695-0839
Practice Address - Fax:937-695-1441
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-000599225100000X
OHPT003579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPT-000599OtherKENTUCKY BOARD OF PHYSICAL THERAPY
OHPT003579OtherOHIO OCCUPATIONALTHERAPY, PHYSICAL THERAPY AND ATHLETIC TRAINER BOARD