Provider Demographics
NPI:1518601582
Name:HARVEY, DONNA RENEE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:RENEE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 NOTTA RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:GA
Mailing Address - Zip Code:31565-5802
Mailing Address - Country:US
Mailing Address - Phone:912-552-0532
Mailing Address - Fax:
Practice Address - Street 1:63 NOTTA RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:GA
Practice Address - Zip Code:31565-5802
Practice Address - Country:US
Practice Address - Phone:912-552-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT007290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty