Provider Demographics
NPI:1154383255
Name:ABBOTT, DONNA (PT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:9 MANHATTAN SQ STE B
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6263
Practice Address - Country:US
Practice Address - Phone:757-825-3400
Practice Address - Fax:757-825-0392
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5423096OtherAETNA
VA192965OtherBCBS PHYSICAL THERAPY
VA650017802OtherRAILROAD MEDICARE
VA8928690Medicaid
VA8928690Medicaid
VAC05954Medicare PIN