Provider Demographics
NPI:1922063130
Name:HASBROUCK, DONNA HUMPHRIES (MS ORTL)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:HUMPHRIES
Last Name:HASBROUCK
Suffix:
Gender:F
Credentials:MS ORTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 W LAKE DR
Mailing Address - Street 2:
Mailing Address - City:W PALM BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33406
Mailing Address - Country:US
Mailing Address - Phone:561-965-6809
Mailing Address - Fax:
Practice Address - Street 1:3230 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461
Practice Address - Country:US
Practice Address - Phone:561-968-7788
Practice Address - Fax:561-968-9969
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT00080872251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic