Provider Demographics
NPI:1740599281
Name:PETKUNAS BYRNE, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:PETKUNAS BYRNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11609 SW HAWTHORNE HILL RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-5420
Mailing Address - Country:US
Mailing Address - Phone:508-340-2826
Mailing Address - Fax:
Practice Address - Street 1:10560 SW STEPHANIE WAY APT 202
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2328
Practice Address - Country:US
Practice Address - Phone:772-238-0702
Practice Address - Fax:772-237-5823
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8788225X00000X
FLOT23840225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist