Provider Demographics
NPI:1255657870
Name:NESSLAR, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:NESSLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10446 PONTOFINO CIR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-7057
Mailing Address - Country:US
Mailing Address - Phone:727-376-4012
Mailing Address - Fax:727-375-7878
Practice Address - Street 1:10446 PONTOFINO CIR
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-7057
Practice Address - Country:US
Practice Address - Phone:727-376-4012
Practice Address - Fax:727-375-7878
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 4823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist