Provider Demographics
NPI:1386818441
Name:MOULIN, DONNA LYNN (LICENSED PHYSICAL TH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:MOULIN
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Gender:F
Credentials:LICENSED PHYSICAL TH
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Mailing Address - Street 1:1403 MILL RACE DRIVE
Mailing Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA INC
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153
Mailing Address - Country:US
Mailing Address - Phone:540-444-0526
Mailing Address - Fax:540-444-0531
Practice Address - Street 1:342 VIRGINIA AVENUE
Practice Address - Street 2:HEARTLAND REHABILITATION SERVICES WYTHEVILLE
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382
Practice Address - Country:US
Practice Address - Phone:276-228-6200
Practice Address - Fax:276-228-9175
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
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Provider Licenses
StateLicense IDTaxonomies
VA2306602469225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant