Provider Demographics
NPI:1952475964
Name:HORRIGAN, DONNA J (PT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:HORRIGAN
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 1:7949 S LEGEND CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8576
Mailing Address - Country:US
Mailing Address - Phone:414-425-3279
Mailing Address - Fax:
Practice Address - Street 1:3970 N OAKLAND AVE
Practice Address - Street 2:SUITE 703
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2265
Practice Address - Country:US
Practice Address - Phone:414-963-6330
Practice Address - Fax:414-963-6331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2322-024174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40181700Medicaid