MEDICARE: DONNA H CMAR BS, PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA19901	FL

General Provider Information

NPI Number	:	1538345574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA H CMAR BS, PTA

Provider Business Mailing Address
First Line	:	9900 DAHLIA AVE
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-5657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 DAHLIA AVE
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-5657
Country	:	US
Telephone Number	:	561-317-4427
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2008
Last Update Date	:	01/19/2008

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