Healthcare Provider Details

I. General information

NPI: 1043481161
Provider Name (Legal Business Name): DONNA MAE HARUE DE WIT P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13432 TULANE STREET
WESTMINSTER CA
92683-1740
US

IV. Provider business mailing address

13432 TULANE STREET
WESTMINSTER CA
92683-1740
US

V. Phone/Fax

Practice location:
  • Phone: 714-206-6780
  • Fax: 714-891-1373
Mailing address:
  • Phone: 714-206-6780
  • Fax: 714-891-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT8089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: