Provider Demographics
NPI:1255327649
Name:THAEMLITZ, DONNA R (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:THAEMLITZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:R
Other - Last Name:SONNHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2129
Mailing Address - Country:US
Mailing Address - Phone:605-334-5630
Mailing Address - Fax:605-332-5327
Practice Address - Street 1:1530 ROWE AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-9700
Practice Address - Country:US
Practice Address - Phone:507-372-2232
Practice Address - Fax:507-372-7326
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN869313OtherARAZ
MN64-05340OtherMEDICA
MN64-11147OtherMEDICA
MNPT4487OtherDAKOTACARE
MN2434OtherAVERA HEALTH PLANS
MN64-03579OtherMEDICA
MN64-03861OtherMEDICA
MN64-04221OtherMEDICA
MN10F22THOtherBLUE CROSS BLUE SHIELD MN
MN23402OtherSIOUX VALLEY HEALTH PLANS