Provider Demographics
NPI:1770824708
Name:DEMATTIA, DONNA L (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:DEMATTIA
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 1:11671 FAIRMONT PL
Mailing Address - Street 2:
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754-9140
Mailing Address - Country:US
Mailing Address - Phone:301-831-9459
Mailing Address - Fax:
Practice Address - Street 1:187 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 6
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4503
Practice Address - Country:US
Practice Address - Phone:301-663-1157
Practice Address - Fax:301-663-1229
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14602225100000X
DCPT544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist