Provider Demographics
NPI:1275745689
Name:KLEM, DONNA DURYEA (PT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:DURYEA
Last Name:KLEM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 KATRINKA DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4734
Mailing Address - Country:US
Mailing Address - Phone:301-464-2568
Mailing Address - Fax:301-262-1056
Practice Address - Street 1:13301 KATRINKA DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4734
Practice Address - Country:US
Practice Address - Phone:301-464-2568
Practice Address - Fax:301-262-1056
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD146802251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS958OtherCAREFIRST BCBS
MDA691DDOtherCAREFIRST BCBS MD
MD2462860OtherAETNA
MD4460475OtherAETNA