Provider Demographics
NPI:1043300338
Name:LEDDY, DONNA M (RPT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:LEDDY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:CREMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 TOMPKINS STREET
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1458
Mailing Address - Country:US
Mailing Address - Phone:203-419-0381
Mailing Address - Fax:203-419-0389
Practice Address - Street 1:385 MAIN ST S
Practice Address - Street 2:SUITE 212
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4240
Practice Address - Country:US
Practice Address - Phone:203-262-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist