Provider Demographics
NPI:1912139221
Name:GALLANT, DONNA A (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:A
Last Name:GALLANT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3292 WINDMILL CIR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-7486
Mailing Address - Country:US
Mailing Address - Phone:850-478-8641
Mailing Address - Fax:
Practice Address - Street 1:2475 E NINE MILE RD STE K
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7796
Practice Address - Country:US
Practice Address - Phone:850-549-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50763174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist