Provider Demographics
NPI:1972662955
Name:DOUGLASS, DONNA W (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:W
Last Name:DOUGLASS
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 1:1020 CROSSPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-0918
Mailing Address - Country:US
Mailing Address - Phone:239-337-2003
Mailing Address - Fax:
Practice Address - Street 1:1020 CROSSPOINTE DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-0918
Practice Address - Country:US
Practice Address - Phone:239-337-2003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME134850000Medicaid
MEDO MM8831Medicare ID - Type UnspecifiedPROVIDER # BEFORE NPI