Provider Demographics
NPI:1376135921
Name:CANTRELL, DONNA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 REMSENS LN
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-4508
Mailing Address - Country:US
Mailing Address - Phone:516-996-2770
Mailing Address - Fax:
Practice Address - Street 1:873 REMSENS LN
Practice Address - Street 2:
Practice Address - City:OYSTER BAY,
Practice Address - State:NY
Practice Address - Zip Code:11771
Practice Address - Country:US
Practice Address - Phone:646-733-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist