Provider Demographics
NPI:1558798926
Name:OSBORNE, DONNA REGINA (LMT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:REGINA
Last Name:OSBORNE
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 1:1632 WARSAW POINTE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2078
Mailing Address - Country:US
Mailing Address - Phone:404-735-5255
Mailing Address - Fax:
Practice Address - Street 1:330 KENNESTONE HOSPITAL BLVD
Practice Address - Street 2:HEALTHPLACE
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1121
Practice Address - Country:US
Practice Address - Phone:770-793-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT005157225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist