Provider Demographics
NPI:1013750256
Name:WHITE, STEPHEN ALLEN II
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ALLEN
Last Name:WHITE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 MUSTANG WAY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-3419
Mailing Address - Country:US
Mailing Address - Phone:724-988-9197
Mailing Address - Fax:
Practice Address - Street 1:2201 CASON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2697
Practice Address - Country:US
Practice Address - Phone:765-447-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06005654A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant