MEDICARE: DONNA DOULONG PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	40QB00303300	NJ

General Provider Information

NPI Number	:	1487076717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA DOULONG PTA

Provider Business Mailing Address
First Line	:	2603A TARNBROOK DR
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2629
Country	:	US
Telephone Number	:	203-257-4906
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603A TARNBROOK DR
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2629
Country	:	US
Telephone Number	:	203-257-4906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	01/06/2014

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Directions to “ DONNA DOULONG PTA” Practice Location

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