Provider Demographics
NPI:1891943403
Name:PARRISH, DONIELLE CAMPBELL (PTA)
Entity Type:Individual
Prefix:
First Name:DONIELLE
Middle Name:CAMPBELL
Last Name:PARRISH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 SW 35TH PL
Mailing Address - Street 2:APT E303
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-9378
Mailing Address - Country:US
Mailing Address - Phone:773-612-2725
Mailing Address - Fax:
Practice Address - Street 1:4600 SW 46TH CT
Practice Address - Street 2:SUITE 140
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5708
Practice Address - Country:US
Practice Address - Phone:352-873-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160003581225200000X
FLPTA 21645225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant