Provider Demographics
NPI:1679677181
Name:WHITE, MELISSA LEE (MS,PT,PCS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS,PT,PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 OAK TRCE
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4517
Mailing Address - Country:US
Mailing Address - Phone:206-682-7442
Mailing Address - Fax:
Practice Address - Street 1:120 OSLO CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-5965
Practice Address - Country:US
Practice Address - Phone:205-944-3939
Practice Address - Fax:205-944-3991
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH22672251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51075271OtherBCBS
ALAL0334Medicare UPIN