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General NPI Number Information
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NPI Number | 1144452731
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Entity Type | Individual
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Provider Name | SUSAN ROSE DONNAL PTA. 03450
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Gender | Female
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 08/14/2009
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Provider Practice Location Address
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Address Line | 1209 INDIANA AVE
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City | SAINT MARYS
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State | OH
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Zip | 45885-1310
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Country | US
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Telephone | 419-394-3258
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Fax | 419-394-4769
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Provider Business Mailing Address
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Address Line | 1815 LEFFLER DR
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City | LIMA
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State | OH
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Zip | 45806-1718
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Country | US
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Telephone | 419-223-4223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 03450
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License Number State | OH
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