Provider Demographics
NPI:1871957662
Name:WHITE, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WHITE
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 1:4491 CRYSTAL LAKE DRIVE
Mailing Address - Street 2:APT 201C
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442
Mailing Address - Country:US
Mailing Address - Phone:954-871-8970
Mailing Address - Fax:
Practice Address - Street 1:3275 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9536
Practice Address - Country:US
Practice Address - Phone:954-428-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist