Provider Demographics
NPI:1194929737
Name:WHITE, TRACI LYNN (LPTA)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MRS
Other - First Name:TRACI
Other - Middle Name:LYNN
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1158 E HORTTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-3105
Mailing Address - Country:US
Mailing Address - Phone:215-910-3662
Mailing Address - Fax:215-247-6006
Practice Address - Street 1:1158 E HORTTER ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19150-3105
Practice Address - Country:US
Practice Address - Phone:215-910-3662
Practice Address - Fax:215-247-6006
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000546225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant