Provider Demographics
NPI:1083902183
Name:ANDERSON, DONNA ELLA (DPT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:ELLA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 E KATELLA AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5958
Mailing Address - Country:US
Mailing Address - Phone:714-712-9222
Mailing Address - Fax:714-937-1314
Practice Address - Street 1:2400 E KATELLA AVE STE 405
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5958
Practice Address - Country:US
Practice Address - Phone:714-712-9222
Practice Address - Fax:714-937-1314
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CA39768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019473Medicaid
NH30399000Medicaid
NH30399000Medicaid