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General NPI Number Information
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NPI Number | 1881862910
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Entity Type | Individual
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Provider Name | COURTNEY LYNN DONALDSON PTA
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Gender | Female
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 200 BRICKSTONE SQ STE 301
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City | ANDOVER
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State | MA
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Zip | 01810-1429
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Country | US
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Telephone | 978-474-7500
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Fax |
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Provider Business Mailing Address
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Address Line | WISHING WELL HEALTH CENTER 1539 COUNTRY CLUB ROAD
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City | FAIRMONT
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State | WV
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Zip | 26554
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Country | US
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Telephone | 304-366-9100
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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 | 1324
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License Number State | WV
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