Provider Demographics
NPI:1629308812
Name:WILLIAMS, DONNA LOU (PT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LOU
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:LOU
Other - Last Name:MAPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4805 N NEWHALL ST
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-6047
Mailing Address - Country:US
Mailing Address - Phone:414-961-0728
Mailing Address - Fax:
Practice Address - Street 1:2115 E WOODSTOCK PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1342
Practice Address - Country:US
Practice Address - Phone:414-271-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10157-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist