Provider Demographics
NPI:1043481161
Name:DE WIT, DONNA MAE HARUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA MAE
Middle Name:HARUE
Last Name:DE WIT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13432 TULANE STREET
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-1740
Mailing Address - Country:US
Mailing Address - Phone:714-206-6780
Mailing Address - Fax:714-891-1373
Practice Address - Street 1:13432 TULANE STREET
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-1740
Practice Address - Country:US
Practice Address - Phone:714-206-6780
Practice Address - Fax:714-891-1373
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT80892251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics