Provider Demographics
NPI:1780841031
Name:MUSSITSCH-MANNING, DONNA MARIA (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIA
Last Name:MUSSITSCH-MANNING
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 1:640 NE EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2027
Mailing Address - Country:US
Mailing Address - Phone:360-834-5055
Mailing Address - Fax:360-834-6970
Practice Address - Street 1:640 NE EVERETT ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2027
Practice Address - Country:US
Practice Address - Phone:360-834-5055
Practice Address - Fax:360-834-6970
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4124225100000X
WA00008498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist