Provider Demographics
NPI:1124417266
Name:DESANTO OTT, DONNA ANN (PT, MS)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:ANN
Last Name:DESANTO OTT
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MEADOWLARK RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9441
Mailing Address - Country:US
Mailing Address - Phone:484-374-0205
Mailing Address - Fax:610-987-9108
Practice Address - Street 1:111 MEADOWLARK RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-9441
Practice Address - Country:US
Practice Address - Phone:484-374-0205
Practice Address - Fax:610-987-9108
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001905E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist