Provider Demographics
NPI:1770796542
Name:DAVIDSON, DONNA KLOKKEVOLD (PT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:KLOKKEVOLD
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:KLOKKEVOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:25960 WHITE SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9668
Mailing Address - Country:US
Mailing Address - Phone:907-694-2545
Mailing Address - Fax:907-694-2545
Practice Address - Street 1:25960 WHITE SPRUCE DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-9668
Practice Address - Country:US
Practice Address - Phone:907-694-2545
Practice Address - Fax:907-694-2545
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKA00652251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics