Provider Demographics
NPI:1104417120
Name:DONNER, CARISSA (DPT)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:DONNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:ORIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:6400 GLENWOOD ST STE 111
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 N ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1730
Practice Address - Country:US
Practice Address - Phone:515-965-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist