Provider Demographics
NPI:1114978756
Name:GRACE, DONNA BROWDER (PT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:BROWDER
Last Name:GRACE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DONNA
Other - Middle Name:DENISE
Other - Last Name:BROWDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 MILLIKEN LN
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-8425
Mailing Address - Country:US
Mailing Address - Phone:404-630-3595
Mailing Address - Fax:404-630-3595
Practice Address - Street 1:40 MILLIKEN LN
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-8425
Practice Address - Country:US
Practice Address - Phone:404-630-3595
Practice Address - Fax:404-630-3595
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005235225100000X, 2251N0400X, 2251P0200X
FLPT28203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000902767AMedicaid