Basic Information
| Provider Information | |||||||||
| NPI: | 1780841031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUSSITSCH-MANNING | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 NE EVERETT ST | ||||||||
| Address2: | |||||||||
| City: | CAMAS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986072027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608345055 | ||||||||
| FaxNumber: | 3608346970 | ||||||||
| Practice Location | |||||||||
| Address1: | 640 NE EVERETT ST | ||||||||
| Address2: | |||||||||
| City: | CAMAS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986072027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608345055 | ||||||||
| FaxNumber: | 3608346970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2008 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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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 | 4124 | OR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 00008498 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.