Active NPI
Michelle Marie White, PTA
- Physical Therapy Assistant
- Dixon, IL
National Provider Identifier
1952519860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160002122
- Practice address
- 403 E 1St St
Suite 318 & 319
Dixon, IL 61021-3116 - Phone
- (815) 285-5591
- Fax
- (815) 285-5592
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160002122 | IL | Primary |
Addresses
Primary practice location
403 E 1St St
Suite 318 & 319
Dixon, IL 61021-3116
Mailing address
1424 Nan Ave
Dixon, IL 61021-1442
Phone (815) 677-2760
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160002122 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738627200000",
"number": "1952519860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1424 NAN AVE",
"city": "DIXON",
"state": "IL",
"postal_code": "610211442",
"telephone_number": "815-677-2760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 E 1ST ST",
"address_2": "SUITE 318 & 319",
"city": "DIXON",
"state": "IL",
"postal_code": "610213116",
"telephone_number": "815-285-5591",
"fax_number": "815-285-5592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "MICHELLE",
"middle_name": "MARIE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2025-02-04",
"certification_date": "2025-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160002122",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dixon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.