Provider Demographics
NPI:1760447486
Name:SMYERS, DONNA A (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:SMYERS
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:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:ADAMANT
Mailing Address - State:VT
Mailing Address - Zip Code:05640-0102
Mailing Address - Country:US
Mailing Address - Phone:802-229-4393
Mailing Address - Fax:802-879-6099
Practice Address - Street 1:5052 CENTER RD
Practice Address - Street 2:
Practice Address - City:ADAMANT
Practice Address - State:VT
Practice Address - Zip Code:05640
Practice Address - Country:US
Practice Address - Phone:802-371-0055
Practice Address - Fax:802-229-5160
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040002945225100000X
CT005279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist