Healthcare Provider Details

I. General information

NPI: 1346545290
Provider Name (Legal Business Name): DONNA MILLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 EAST 10TH STREET
SAITN CLOUD FL
34769
US

IV. Provider business mailing address

335 E 10TH ST
SAINT CLOUD FL
34769-3905
US

V. Phone/Fax

Practice location:
  • Phone: 800-521-9604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA11117
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: