1881747061 NPI number — DONNA M MATHISEN MS, RPT

Table of content: DONNA M MATHISEN MS, RPT (NPI 1881747061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881747061 NPI number — DONNA M MATHISEN MS, RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHISEN
Provider First Name:
DONNA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881747061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1217 S EAST AVE
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34239-2344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-362-2000
Provider Business Mailing Address Fax Number:
941-362-9114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1217 S EAST AVE
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34239-2344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-362-2000
Provider Business Practice Location Address Fax Number:
941-362-9114
Provider Enumeration Date:
01/19/2007

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: 174400000X , with the licence number:  PT0012183 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PT0012183 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Y6975 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com