Provider Demographics
NPI:1043501489
Name:SANDERSON, DONNA L (PTA)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:L
Last Name:SANDERSON
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 1:27 GEORGE ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-2510
Mailing Address - Country:US
Mailing Address - Phone:508-269-0138
Mailing Address - Fax:
Practice Address - Street 1:27 GEORGE ST
Practice Address - Street 2:APARTMENT 2
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-2510
Practice Address - Country:US
Practice Address - Phone:508-269-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2615225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225200000XOtherPHYSICAL THERAPIST ASSISTANT