Provider Demographics
NPI:1104161587
Name:MORTON, DONNA (LMP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MORTON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 MILTON WAY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9382
Mailing Address - Country:US
Mailing Address - Phone:253-952-0302
Mailing Address - Fax:253-953-0307
Practice Address - Street 1:2748 MILTON WAY
Practice Address - Street 2:SUITE 211
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9382
Practice Address - Country:US
Practice Address - Phone:253-952-0302
Practice Address - Fax:253-953-0307
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60319952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist