Provider Demographics
NPI:1295844942
Name:SARGENT, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:SARGENT
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 1:42 MOSHER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2122
Mailing Address - Country:US
Mailing Address - Phone:207-767-2317
Mailing Address - Fax:
Practice Address - Street 1:462 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1818
Practice Address - Country:US
Practice Address - Phone:207-324-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPT1597OtherLICENSE #