Provider Demographics
NPI:1073102646
Name:WHITE, ISABELLE LARAE (LMT)
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:LARAE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 FLINT MEADOW DR STE 104
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-9570
Mailing Address - Country:US
Mailing Address - Phone:619-738-4403
Mailing Address - Fax:
Practice Address - Street 1:1246 FLINT MEADOW DR
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-9570
Practice Address - Country:US
Practice Address - Phone:619-738-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13427595-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty