Provider Demographics
NPI:1124273719
Name:WORTHY, DONNA C (MPT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:C
Last Name:WORTHY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75TH MED 168 MMB
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96260
Mailing Address - Country:US
Mailing Address - Phone:0505-764-8681
Mailing Address - Fax:0505-764-4802
Practice Address - Street 1:3816 S CLEAR CREEK RD
Practice Address - Street 2:STE B
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4400
Practice Address - Country:US
Practice Address - Phone:254-699-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1184238225100000X
VA2305202358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist