Basic Information
| Provider Information | |||||||||
| NPI: | 1417039793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | AMIE KAYE | ||||||||
| MiddleName: | DERRICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 IVY CT | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296783023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648824171 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12023 NORTH RADIO STATION ROAD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8649850770 | ||||||||
| FaxNumber: | 8649851771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 11/29/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 4873 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.