Provider Demographics
NPI:1073852711
Name:CULLEN, DONNA MARIE (PTA)
Entity Type:Individual
Prefix:MR
First Name:DONNA
Middle Name:MARIE
Last Name:CULLEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ROUND HEAD DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18255-3721
Mailing Address - Country:US
Mailing Address - Phone:570-427-4340
Mailing Address - Fax:
Practice Address - Street 1:525 ROUND HEAD DR
Practice Address - Street 2:
Practice Address - City:WEATHERLY
Practice Address - State:PA
Practice Address - Zip Code:18255-3721
Practice Address - Country:US
Practice Address - Phone:570-427-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000739225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant