Provider Demographics
NPI:1174592943
Name:WHITE, PAMELA STRADLEY (PT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:STRADLEY
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 HARBOUR COVE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4274
Mailing Address - Country:US
Mailing Address - Phone:678-566-3924
Mailing Address - Fax:
Practice Address - Street 1:4320 HARBOUR COVE CT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4274
Practice Address - Country:US
Practice Address - Phone:678-566-3924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist