Provider Demographics
NPI:1801974043
Name:VACHON, DONNA BETH (PTA)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:BETH
Last Name:VACHON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1315
Mailing Address - Country:US
Mailing Address - Phone:508-833-4763
Mailing Address - Fax:
Practice Address - Street 1:316 ROUTE 28
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-4619
Practice Address - Country:US
Practice Address - Phone:508-771-2034
Practice Address - Fax:508-771-5973
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200OtherPT ASSISTANT LIC. NUMBER