Provider Demographics
NPI:1043355746
Name:CORDOVA, DONNA BOGDAN (PT)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:BOGDAN
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:BOGDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:13 EMERY DR
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NH
Mailing Address - Zip Code:03811-2157
Mailing Address - Country:US
Mailing Address - Phone:603-362-6544
Mailing Address - Fax:
Practice Address - Street 1:450 LOWELL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-5305
Practice Address - Country:US
Practice Address - Phone:978-475-4056
Practice Address - Fax:978-475-4046
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104112251P0200X
NH18342251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68586OtherBLUE CROSS - BLUE SHIELD