Healthcare Provider Details

I. General information

NPI: 1730424128
Provider Name (Legal Business Name): DONNA FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 LIVERMORE FALLS RD
FARMINGTON ME
04938-6241
US

IV. Provider business mailing address

269 FAIRBANKS RD
FARMINGTON ME
04938-5723
US

V. Phone/Fax

Practice location:
  • Phone: 207-778-6591
  • Fax: 207-779-0862
Mailing address:
  • Phone: 860-558-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPA3833
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: