Provider Demographics
NPI:1316945777
Name:PLANTE, DONNA (PT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:PLANTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:PLANTE
Other - Last Name:JOHNSON AND BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:28 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:VT
Mailing Address - Zip Code:05743-1053
Mailing Address - Country:US
Mailing Address - Phone:802-265-4055
Mailing Address - Fax:802-265-8838
Practice Address - Street 1:28 4TH ST
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:VT
Practice Address - Zip Code:05743-1053
Practice Address - Country:US
Practice Address - Phone:802-265-4055
Practice Address - Fax:802-265-8838
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008592-1225100000X
VT040-0002384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2494Medicaid
VTOVN2494Medicaid
NYBB5756Medicare ID - Type UnspecifiedUPSTATE MEDICARE DIVISION