Provider Demographics
NPI:1164010054
Name:WALDROP, DONNA (MT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:WALDROP
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-9495
Mailing Address - Country:US
Mailing Address - Phone:719-445-9414
Mailing Address - Fax:
Practice Address - Street 1:7230 PARTRIDGE DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-9495
Practice Address - Country:US
Practice Address - Phone:719-445-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT20411225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist