Provider Demographics
NPI:1275964686
Name:BESICK, DONNA J
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:J
Last Name:BESICK
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:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:KEOSAUQUA
Mailing Address - State:IA
Mailing Address - Zip Code:52565-0128
Mailing Address - Country:US
Mailing Address - Phone:319-293-8250
Mailing Address - Fax:319-293-3632
Practice Address - Street 1:2000 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556
Practice Address - Country:US
Practice Address - Phone:641-469-4353
Practice Address - Fax:641-469-4288
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00736225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant