Basic Information
| Provider Information | |||||||||
| NPI: | 1356569313 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLOWERS | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PT, ATC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FLOWERS | ||||||||
| OtherFirstName: | DONNA | ||||||||
| OtherMiddleName: | BURDEN | ||||||||
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| OtherCredential: | PT, ATC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 SHIRE CT | ||||||||
| Address2: | |||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950321632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083736392 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14675 WINCHESTER BLVD | ||||||||
| Address2: | BAYSPORT PT | ||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950321816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083958851 | ||||||||
| FaxNumber: | 4083958841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 05/04/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT14840 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.