Provider Demographics
NPI:1437486156
Name:COMITO, DONNA PEARL (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:PEARL
Last Name:COMITO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-8881
Mailing Address - Country:US
Mailing Address - Phone:843-240-1400
Mailing Address - Fax:
Practice Address - Street 1:1244 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-8881
Practice Address - Country:US
Practice Address - Phone:843-240-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60205225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist