Provider Demographics
NPI:1407191422
Name:BERRYHILL, DONNA JEAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JEAN
Last Name:BERRYHILL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-1625
Mailing Address - Country:US
Mailing Address - Phone:918-978-8877
Mailing Address - Fax:
Practice Address - Street 1:2300 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-1625
Practice Address - Country:US
Practice Address - Phone:918-978-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK350225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant