Provider Demographics
NPI:1194985259
Name:ENMON, DONNA LEE (PT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LEE
Last Name:ENMON
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 1002
Mailing Address - Street 2:
Mailing Address - City:MC CAMEY
Mailing Address - State:TX
Mailing Address - Zip Code:79752-1002
Mailing Address - Country:US
Mailing Address - Phone:432-652-8521
Mailing Address - Fax:432-652-4025
Practice Address - Street 1:1604 BURLESON AVE
Practice Address - Street 2:
Practice Address - City:MCCAMEY
Practice Address - State:TX
Practice Address - Zip Code:79752-1002
Practice Address - Country:US
Practice Address - Phone:432-652-4030
Practice Address - Fax:432-652-4025
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101700-2225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist