Provider Demographics
NPI:1215694401
Name:WHITE, HELEN TERESA
Entity type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:TERESA
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 1:607 W ASH ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-1852
Mailing Address - Country:US
Mailing Address - Phone:850-295-4389
Mailing Address - Fax:
Practice Address - Street 1:1708 S BYRON BUTLER PKWY STE D
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32348-5513
Practice Address - Country:US
Practice Address - Phone:850-295-4389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL12846291744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management