Healthcare Provider Details

I. General information

NPI: 1194985259
Provider Name (Legal Business Name): DONNA LEE ENMON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 BURLESON AVE
MCCAMEY TX
79752-1002
US

IV. Provider business mailing address

PO BOX 1002
MC CAMEY TX
79752-1002
US

V. Phone/Fax

Practice location:
  • Phone: 432-652-4030
  • Fax: 432-652-4025
Mailing address:
  • Phone: 432-652-8521
  • Fax: 432-652-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number101700-2
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: