Provider Demographics
NPI:1972896108
Name:WAJDA, DONNA L (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:L
Last Name:WAJDA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 FRANKLIN TPKE
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1848
Mailing Address - Country:US
Mailing Address - Phone:201-493-7440
Mailing Address - Fax:201-493-7445
Practice Address - Street 1:168 FRANKLIN TPKE
Practice Address - Street 2:SUITE 103B
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1848
Practice Address - Country:US
Practice Address - Phone:201-493-7440
Practice Address - Fax:201-493-7445
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01396000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist