Healthcare Provider Details

I. General information

NPI: 1558776153
Provider Name (Legal Business Name): DONNA ZATYKO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. DONNA BUNNELL

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 HICKORY DR
FORT PIERCE FL
34982-8603
US

IV. Provider business mailing address

5911 HICKORY DR
FORT PIERCE FL
34982-8603
US

V. Phone/Fax

Practice location:
  • Phone: 772-882-7329
  • Fax:
Mailing address:
  • Phone: 772-882-7329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMA23260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: