1437348992 NPI number — MRS. DONNA MICHELLE O'CONNELL PHYSICAL THERAPIST

Table of content: MRS. DONNA MICHELLE O'CONNELL PHYSICAL THERAPIST (NPI 1437348992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437348992 NPI number — MRS. DONNA MICHELLE O'CONNELL PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'CONNELL
Provider First Name:
DONNA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAUVAGEAU
Provider Other First Name:
DONNA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437348992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20347 TIMBERLAKE RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24502-7352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-296-3203
Provider Business Mailing Address Fax Number:
434-509-1695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12281 MONETA RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONETA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24121-6402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-296-3203
Provider Business Practice Location Address Fax Number:
434-509-1695
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305004892 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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