Provider Demographics
NPI:1730662883
Name:SECURA, DONNA JO BILLIE (LMT)
Entity Type:Individual
Prefix:
First Name:DONNA JO
Middle Name:BILLIE
Last Name:SECURA
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 1:1738 BLUEBIRD CT
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4550
Mailing Address - Country:US
Mailing Address - Phone:321-591-9539
Mailing Address - Fax:
Practice Address - Street 1:1738 BLUEBIRD CT
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4550
Practice Address - Country:US
Practice Address - Phone:321-591-9539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38318225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty