Provider Demographics
NPI:1457534299
Name:PATRICK, DONNA J (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:PATRICK
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 1:5 ROLLING MDWS
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-8805
Mailing Address - Country:US
Mailing Address - Phone:304-757-3104
Mailing Address - Fax:
Practice Address - Street 1:5 ROLLING MDWS
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-8805
Practice Address - Country:US
Practice Address - Phone:304-757-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-16
Last Update Date:2007-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT001226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist