Provider Demographics
NPI:1952294035
Name:WHITE, ALEXA SPARKS (PTA)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:SPARKS
Last Name:WHITE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SHADY COVE EXT
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MS
Mailing Address - Zip Code:38827-9781
Mailing Address - Country:US
Mailing Address - Phone:662-279-5910
Mailing Address - Fax:
Practice Address - Street 1:24 SHADY COVE EXT
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MS
Practice Address - Zip Code:38827-9781
Practice Address - Country:US
Practice Address - Phone:662-279-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5737225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant