Provider Demographics
NPI:1629266044
Name:DEHAAS, DONNA E (LMT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:E
Last Name:DEHAAS
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 1:4189 CASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-2309
Mailing Address - Country:US
Mailing Address - Phone:352-683-6243
Mailing Address - Fax:352-683-3104
Practice Address - Street 1:1292 LORI DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4561
Practice Address - Country:US
Practice Address - Phone:352-686-4998
Practice Address - Fax:352-686-4998
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 51425225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist