Provider Demographics
NPI:1831846401
Name:BOONE, DONNA MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MICHELLE
Last Name:BOONE
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 1:187 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72131-8469
Mailing Address - Country:US
Mailing Address - Phone:501-593-5664
Mailing Address - Fax:
Practice Address - Street 1:401 SOUTHRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-8853
Practice Address - Country:US
Practice Address - Phone:501-362-7023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist