Provider Demographics
NPI:1154852804
Name:FEDENA, DONNA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:FEDENA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:GIORDANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 W. ASHLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036
Mailing Address - Country:US
Mailing Address - Phone:484-494-5604
Mailing Address - Fax:610-461-7423
Practice Address - Street 1:901 W. ASHLAND AVE.
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036
Practice Address - Country:US
Practice Address - Phone:484-494-5604
Practice Address - Fax:610-461-7423
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE011328225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant