Provider Demographics
NPI:1316961030
Name:LONGO, DONNA A (PT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:A
Last Name:LONGO
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 1:6718 CANARY PALM CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6462
Mailing Address - Country:US
Mailing Address - Phone:561-392-5092
Mailing Address - Fax:561-245-8943
Practice Address - Street 1:22971 VIA DE SONRISA DEL NORTE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3905
Practice Address - Country:US
Practice Address - Phone:561-955-9384
Practice Address - Fax:561-392-7395
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0560OtherBLUE CROSS BLUE SHIELD
FLY0560OtherBLUE CROSS BLUE SHIELD
FLE4447BMedicare ID - Type Unspecified