Provider Demographics
NPI:1316480742
Name:FIELDS, DONNA (CPTA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26790 HIGHWAY 24
Mailing Address - Street 2:UNITED STATES
Mailing Address - City:SAINT MARYS
Mailing Address - State:KS
Mailing Address - Zip Code:66536-9739
Mailing Address - Country:US
Mailing Address - Phone:785-437-3164
Mailing Address - Fax:
Practice Address - Street 1:6300 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1013
Practice Address - Country:US
Practice Address - Phone:785-250-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-03
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03035225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant