Provider Demographics
NPI:1659599686
Name:HERMANCE, DONNA BECK (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:BECK
Last Name:HERMANCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 CHASE RD
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1538
Mailing Address - Country:US
Mailing Address - Phone:574-737-7404
Mailing Address - Fax:
Practice Address - Street 1:NORTHCENTRAL INDIANA SPORTS CENTER
Practice Address - Street 2:1603 CHASE ROAD
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947
Practice Address - Country:US
Practice Address - Phone:574-737-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001187A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist