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General NPI Number Information
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NPI Number | 1952832339
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Entity Type | Individual
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Provider Name | DIANNA L MCDONALD PTA
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Gender | Female
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 4606 CLYDE MORRIS BLVD STE 1D
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City | PORT ORANGE
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State | FL
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Zip | 32129-7453
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Country | US
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Telephone | 386-492-2986
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Fax | 386-492-2987
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Provider Business Mailing Address
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Address Line | 442 NASH LN
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City | PORT ORANGE
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State | FL
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Zip | 32127-9524
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Country | US
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Telephone | 618-567-6350
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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 | PTA27252
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License Number State | FL
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